Provider Demographics
NPI:1124368477
Name:VISTA REHAB SERVICES
Entity Type:Organization
Organization Name:VISTA REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:732-634-5980
Mailing Address - Street 1:185 GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095
Mailing Address - Country:US
Mailing Address - Phone:732-634-5980
Mailing Address - Fax:732-634-9508
Practice Address - Street 1:185 GREEN STREET
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-634-5980
Practice Address - Fax:732-634-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency