Provider Demographics
NPI:1710937396
Name:NEW VISTAS-MOUNTAIN LAUREL, INC.
Entity Type:Organization
Organization Name:NEW VISTAS-MOUNTAIN LAUREL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-277-7743
Mailing Address - Street 1:900 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1734
Mailing Address - Country:US
Mailing Address - Phone:828-697-4160
Mailing Address - Fax:828-693-9560
Practice Address - Street 1:800 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3528
Practice Address - Country:US
Practice Address - Phone:828-692-5741
Practice Address - Fax:828-693-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005720Medicaid
NC5902736Medicaid
NC2335660CMedicare ID - Type UnspecifiedDR. GROUP - FLEMING
NC2335660EMedicare ID - Type UnspecifiedPHD GROUP-FLEMING
NC6005720Medicaid