Healthcare Provider Details

I. General information

NPI: 1336636182
Provider Name (Legal Business Name): VISTA ADULT DAYCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 BRENWOOD CIR
KATY TX
77449-1435
US

IV. Provider business mailing address

6250 BRENWOOD CIR
KATY TX
77449-1435
US

V. Phone/Fax

Practice location:
  • Phone: 301-433-5794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERALDINE RAPHAEL
Title or Position: DIRECTOR
Credential:
Phone: 301-433-5794