Healthcare Provider Details

I. General information

NPI: 1831898253
Provider Name (Legal Business Name): VISTA HEALTH CARE SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HIGHLAND AVE STE 304
SALEM MA
01970-2733
US

IV. Provider business mailing address

9 VISTA AVE
SALEM MA
01970-1027
US

V. Phone/Fax

Practice location:
  • Phone: 781-521-0302
  • Fax:
Mailing address:
  • Phone: 781-521-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ABILA PRIMUS BENAZEA
Title or Position: CEO
Credential: DNP
Phone: 781-521-0302