Healthcare Provider Details

I. General information

NPI: 1609950815
Provider Name (Legal Business Name): VISTA CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 N SPRUCE STREET
TUBA CITY AZ
86045
US

IV. Provider business mailing address

PO BOX 2257
TUBA CITY AZ
86045-2257
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-6308
  • Fax: 928-283-6848
Mailing address:
  • Phone: 928-283-6308
  • Fax: 928-283-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberNAVAJO NATION WAIVER
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberNAVAJO NATION WAIVER
License Number StateAZ

VIII. Authorized Official

Name: MR. BROOKE E BALCH
Title or Position: CFO OF THREE SPRINGS, INC.
Credential:
Phone: 256-880-3339