Provider Demographics
NPI:1093845422
Name:VISTA GUIDANCE CENTERS, INC.
Entity Type:Organization
Organization Name:VISTA GUIDANCE CENTERS, INC.
Other - Org Name:REDLANDS YUCAIPA GUIDANCE CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GERNERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-335-7067
Mailing Address - Street 1:PO BOX 7369
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0369
Mailing Address - Country:US
Mailing Address - Phone:909-335-7067
Mailing Address - Fax:909-792-2045
Practice Address - Street 1:34324 YUCAIPA BLVD
Practice Address - Street 2:SUITE B-D
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2496
Practice Address - Country:US
Practice Address - Phone:909-790-1300
Practice Address - Fax:909-797-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360023AN101YA0400X
CA240000192251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3661Medicaid
CA36A9Medicaid
CAH69445Medicare UPIN
CAH51590Medicare UPIN
CAZZZ23619ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER
CAA27300Medicare UPIN
CAF66816Medicare UPIN
CA3661Medicaid