Provider Demographics
NPI:1609938513
Name:THE VISTA FOUNDATION
Entity Type:Organization
Organization Name:THE VISTA FOUNDATION
Other - Org Name:EARLY INTERVENTION BEHAVIOR INTERVENTION
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-583-5102
Mailing Address - Street 1:1021 SPRINGBOARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1715
Mailing Address - Country:US
Mailing Address - Phone:717-835-0310
Mailing Address - Fax:717-835-0314
Practice Address - Street 1:1021 SPRINGBOARD DRIVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1715
Practice Address - Country:US
Practice Address - Phone:717-835-0310
Practice Address - Fax:717-835-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013916350008Medicaid
PA1013916350009Medicaid