Healthcare Provider Details

I. General information

NPI: 1609666015
Provider Name (Legal Business Name): MINDVISTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7418 S 28TH PL
PHOENIX AZ
85042-7171
US

IV. Provider business mailing address

7418 S 28TH PL
PHOENIX AZ
85042-7171
US

V. Phone/Fax

Practice location:
  • Phone: 626-747-3424
  • Fax:
Mailing address:
  • Phone: 626-747-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: HIRENKUMAR DUDHAT
Title or Position: OWNER
Credential:
Phone: 626-747-3424