Provider Demographics
NPI:1285024679
Name:VISTA ADULT CARE LLC
Entity Type:Organization
Organization Name:VISTA ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER.
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONCIO
Authorized Official - Middle Name:MACAISA
Authorized Official - Last Name:MOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-338-2320
Mailing Address - Street 1:1079 RICCO DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-6603
Mailing Address - Country:US
Mailing Address - Phone:775-338-2320
Mailing Address - Fax:775-360-6000
Practice Address - Street 1:3056 WATERFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-1627
Practice Address - Country:US
Practice Address - Phone:775-338-2320
Practice Address - Fax:775-360-6000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA ADULT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5849AGC320600000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10343-AGC-0OtherDPBH