Provider Demographics
NPI:1477891489
Name:VISTA ADULT CARE, INC.
Entity Type:Organization
Organization Name:VISTA ADULT CARE, INC.
Other - Org Name:VISTA ADULT CARE III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:CASUPANAN
Authorized Official - Last Name:MOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-338-3886
Mailing Address - Street 1:7300 PAH RAH DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9081
Mailing Address - Country:US
Mailing Address - Phone:775-338-3886
Mailing Address - Fax:775-360-6000
Practice Address - Street 1:7300 PAH RAH DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-9081
Practice Address - Country:US
Practice Address - Phone:775-338-3886
Practice Address - Fax:775-360-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7429AGC-2320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities