COLLEGE VISTA, LLC
NPI 1194195164
Skilled Nursing Facility in Los Angeles, CA

Active since October 02, 2015CLIA 05D0902098 · Waiver
4681 NORTH EAGLE ROCK BLVD, LOS ANGELES, CA 90041(323) 257-8151(323) 257-2187 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Mar 23, 2026, Oct 2, 2015 (2 updates tracked since 2015).

About College Vista, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLLEGE VISTA, LLC (NPI 1194195164), doing business as College Vista Convalescent Hospital, is a healthcare organization registered as a skilled nursing facility in Los Angeles, California and active in the NPI registry since October 2015. The organization holds a CLIA Waiver certificate valid through June 12, 2027 and lists Adrian Dehghanmanesh, Cfo, as its authorized official.

NPPES Registry Identity

NPI1194195164
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCOLLEGE VISTA, LLC
Location Address4681 NORTH EAGLE ROCK BLVDLos Angeles, CA 90041
Mailing Address3050 Saturn St Ste 201Brea, CA 92821-6278 · (714) 577-3880 · Fax (714) 577-3895
Fax(323) 257-2187
Organization SubpartNo
Authorized OfficialAdrian DehghanmaneshCfo · (714) 577-3880
Enumeration DateOctober 2, 2015
Last NPPES UpdateMarch 23, 20262 updates tracked since enumeration
NPPES CertifiedMarch 23, 2026
NPI 1194195164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in CA · 970000044
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
4681 NORTH EAGLE ROCK BLVD, Los Angeles, CA 90041

Other Names 2

Doing Business AsCollege Vista Convalescent Hospital
Doing Business AsCollege Vista Post-acute

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0902098

College Vista Post Acute · Los Angeles, CA
Active · expires Jun 12, 2027
CLIA Number05D0902098
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJune 13, 2025
Certificate Expiration DateJune 12, 2027
Laboratory DirectorPablo Bassuk
Laboratory Phone(323) 257-8151
Laboratory LocationCollege Vista Post Acute4681 Eagle Rock Boulevard, Los Angeles, CA 90041
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is College Vista, LLC's NPI number?

The NPI number for College Vista, LLC is 1194195164. It was assigned to this organization in the NPPES registry on October 2, 2015. The provider is doing business as College Vista Convalescent Hospital and College Vista Post-Acute.

Where is College Vista, LLC located?

College Vista, LLC is located at 4681 North Eagle Rock Blvd, Los Angeles, CA 90041. The listed phone number is (323) 257-8151.

What is College Vista, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does College Vista, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0902098) is associated with this NPI, valid through June 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for College Vista, LLC was last updated on March 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.