Provider Demographics
NPI:1467067876
Name:VISTAN HEALTHCARE INC
Entity Type:Organization
Organization Name:VISTAN HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-232-1045
Mailing Address - Street 1:9894 BISSONNET ST STE 394
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8241
Mailing Address - Country:US
Mailing Address - Phone:832-232-1045
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST STE 394
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8241
Practice Address - Country:US
Practice Address - Phone:832-232-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based