Provider Demographics
NPI: | 1003211152 |
---|---|
Name: | IMPERIAL VISTA HEALTH CARE STAFFING, LLC |
Entity Type: | Organization |
Organization Name: | IMPERIAL VISTA HEALTH CARE STAFFING, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF OPERATIONS |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SUCHETA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | SATHE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BS, LMT |
Authorized Official - Phone: | 732-213-1343 |
Mailing Address - Street 1: | 401 RIDGE RD STE 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | DAYTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08810-3300 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-230-3076 |
Mailing Address - Fax: | 732-230-3079 |
Practice Address - Street 1: | 260 S MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | LODI |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07644-2117 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-230-3076 |
Practice Address - Fax: | 732-230-3079 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-31 |
Last Update Date: | 2016-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |