Provider Demographics
NPI:1043265473
Name:VISTACARE USA, INC.
Entity Type:Organization
Organization Name:VISTACARE USA, INC.
Other - Org Name:VISTACARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-922-9711
Mailing Address - Street 1:717 N HARWOOD ST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6519
Mailing Address - Country:US
Mailing Address - Phone:214-922-9711
Mailing Address - Fax:214-922-9752
Practice Address - Street 1:6420 E BROADWAY BLVD
Practice Address - Street 2:SUITE B-200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3534
Practice Address - Country:US
Practice Address - Phone:520-318-0700
Practice Address - Fax:520-318-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC-1113251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ489452Medicaid
AZ489452Medicaid