Healthcare Provider Details

I. General information

NPI: 1306289939
Provider Name (Legal Business Name): VISTA ADULT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 04/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 NW 2ND ST
MIAMI FL
33126-8000
US

IV. Provider business mailing address

7941 NW 2ND ST
MIAMI FL
33126-8000
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-7853
  • Fax: 305-266-7854
Mailing address:
  • Phone: 305-266-7853
  • Fax: 305-266-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9178
License Number StateFL

VIII. Authorized Official

Name: ANNABELLY LUIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-321-1002