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NPI Code Detail

MEDICARE: VISTA RECOVERY CENTER

MEDICARE: VISTA RECOVERY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1598960874
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA RECOVERY CENTER
Provider Business Mailing Address
First Line : PO BOX 7369
Second Line :
City : REDLANDS
State : CA
Zip : 92375-0369
Country : US
Telephone Number : 909-792-0747
Fax Number : 909-792-0033
Provider Business Practice Location Address
First Line : 939 N D ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92418-0001
Country : US
Telephone Number : 909-381-5100
Fax Number : 909-792-0033
Authorized Official
Title or Position : PROJECT MANAGER
Name : MAURINE WHITE
Credential :
Telephone Number : 909-792-0747
Provider Enumeration Date : 06/18/2007
Last Update Date : 08/22/2020

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Directions to “VISTA RECOVERY CENTER ” Practice Location

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