Healthcare Provider Details

I. General information

NPI: 1508479643
Provider Name (Legal Business Name): REMI VISTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10387 PORTA DEGO WAY
REDDING CA
96003-9289
US

IV. Provider business mailing address

PO BOX 494100
REDDING CA
96049-4100
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-4716
  • Fax: 530-224-7168
Mailing address:
  • Phone: 530-245-5805
  • Fax: 530-245-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACEY JO MONSON
Title or Position: BILLING/CONTRACTS ADMINISTRATOR
Credential:
Phone: 530-245-5808