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General NPI Number Information
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NPI Number | 1720820178
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Entity Type | Organization
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Legal Business Name | NEW VISTAS RECOVERY, INC.
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 4983 SONOMA HIGHWAY SUITE M
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City | SANTA ROSA
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State | CA
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Zip | 95409
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Country | US
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Telephone | 707-934-7543
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 WARM SPRINGS ROAD
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City | GLEN ELLEN
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State | CA
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Zip | 95442
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Country | US
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Telephone | 707-996-6716
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Fax | 707-996-6647
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LISA KIDD
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Credential |
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Telephone | 707-996-6716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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