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NPI Code Detail

MEDICARE: VISTA RECOVERY SYSTEMS, INC

MEDICARE: VISTA RECOVERY SYSTEMS, INC
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
1251S00000XCommunity/Behavioral Health AgencyLPC0000002819TN

General Provider Information

NPI Number : 1487992939
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA RECOVERY SYSTEMS, INC
Provider Business Mailing Address
First Line : 3114 BROWNS MILL RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-1417
Country : US
Telephone Number : 423-631-0432
Fax Number : 423-631-0284
Provider Business Practice Location Address
First Line : 3114 BROWNS MILL RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-1417
Country : US
Telephone Number : 423-631-0432
Fax Number : 423-631-0284
Authorized Official
Title or Position : SECRATARY
Name : TEDDY LEROY MOOREHOUSE
Credential : LPC
Telephone Number : 423-631-0432
Provider Enumeration Date : 01/17/2013
Last Update Date : 01/17/2013

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Directions to “VISTA RECOVERY SYSTEMS, INC ” Practice Location

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