MEDICARE: VISTA HOSPICE CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	12-004875-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447505144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA HOSPICE CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	6640 PARKDALE PL STE R
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4698
Country	:	US
Telephone Number	:	317-272-0975
Fax Number	:	317-272-1060

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	MS. JANET COMBS
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	01/15/2025

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