Healthcare Provider Details

I. General information

NPI: 1548984727
Provider Name (Legal Business Name): VISIT HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 LARK AVE STE 240
LOS GATOS CA
95032-2564
US

IV. Provider business mailing address

16400 LARK AVE STE 240
LOS GATOS CA
95032-2564
US

V. Phone/Fax

Practice location:
  • Phone: 408-384-9717
  • Fax:
Mailing address:
  • Phone: 650-331-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: CHRIS KOONE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 502-215-7331