Healthcare Provider Details

I. General information

NPI: 1477891489
Provider Name (Legal Business Name): VISTA ADULT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 PAH RAH DR
SPARKS NV
89436-9081
US

IV. Provider business mailing address

7300 PAH RAH DR
SPARKS NV
89436-9081
US

V. Phone/Fax

Practice location:
  • Phone: 775-338-3886
  • Fax: 775-360-6000
Mailing address:
  • Phone: 775-338-3886
  • Fax: 775-360-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number7429AGC-2
License Number StateNV

VIII. Authorized Official

Name: MRS. EVANGELINE CASUPANAN MOLINO
Title or Position: ADMINISTRATOR
Credential:
Phone: 775-338-3886