Provider Demographics
NPI:1386847085
Name:MISTA CARE INC.
Entity Type:Organization
Organization Name:MISTA CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILIP-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BSN
Authorized Official - Phone:781-572-2722
Mailing Address - Street 1:6717 BEEMAN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-1803
Mailing Address - Country:US
Mailing Address - Phone:781-572-2722
Mailing Address - Fax:
Practice Address - Street 1:6717 BEEMAN DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-1803
Practice Address - Country:US
Practice Address - Phone:781-572-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24774401320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities