Provider Demographics
NPI:1255466306
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:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:BORJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-7067
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 1:1323 W COLTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4554
Practice Address - Country:US
Practice Address - Phone:909-335-7067
Practice Address - Fax:909-792-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360023BN101YA0400X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3617Medicaid
CA3605Medicaid
CAG96668Medicare UPIN
CAF01159Medicare UPIN
CAA93566Medicare UPIN
CAA85616Medicare UPIN
CAZZZ23619ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER
CAH51590Medicare UPIN
CA3617Medicaid
CAH69445Medicare UPIN
CA3605Medicaid