Healthcare Provider Details

I. General information

NPI: 1780443549
Provider Name (Legal Business Name): VISTA SUPPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 NEW JERSEY AVE SE STE 246
WASHINGTON DC
20003-5079
US

IV. Provider business mailing address

853 NEW JERSEY AVE SE STE 246
WASHINGTON DC
20003-5079
US

V. Phone/Fax

Practice location:
  • Phone: 833-698-4782
  • Fax:
Mailing address:
  • Phone: 833-698-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS TAMARA MYERS-BROWN
Title or Position: CHIEF INNOVATION OFFICER/FOUNDER/CE
Credential:
Phone: 301-609-2686