Healthcare Provider Details

I. General information

NPI: 1205986353
Provider Name (Legal Business Name): NEW VISTAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 PARKWAY DR STE A
SANTA FE NM
87507-6201
US

IV. Provider business mailing address

1205 PARKWAY DR STE A
SANTA FE NM
87507-6201
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-1001
  • Fax: 505-424-4778
Mailing address:
  • Phone: 505-471-1001
  • Fax: 505-424-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: RONALD I GARCIA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-471-1001