=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780443549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISTA SUPPORTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2024
-----------------------------------------------------
Last Update Date | 03/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 853 NEW JERSEY AVE SE STE 246
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20003-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-698-4782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 853 NEW JERSEY AVE SE STE 246
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20003-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-698-4782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF INNOVATION OFFICER/FOUNDER/CE
-----------------------------------------------------
Name | PRECIOUS TAMARA MYERS-BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-609-2686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225CA2500X
-----------------------------------------------------
Taxonomy Name | Assistive Technology Supplier Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225CA2400X
-----------------------------------------------------
Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------