Provider Demographics
NPI:1407973514
Name:VISTA GUIDANCE CENTERS, INC.
Entity Type:Organization
Organization Name:VISTA GUIDANCE CENTERS, INC.
Other - Org Name:REDLANDS YUCAIPA GUIDANCE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:J
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 1:790 BEAUMONT AVE STE 210
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5900
Practice Address - Country:US
Practice Address - Phone:951-769-7436
Practice Address - Fax:951-769-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330070AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3383Medicaid