Provider Demographics
NPI:1821424243
Name:VISTAS HOME CARE, INC.
Entity Type:Organization
Organization Name:VISTAS HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:N.KEMDI
Authorized Official - Middle Name:
Authorized Official - Last Name:IHENACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-904-7050
Mailing Address - Street 1:PO BOX 870828
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-0021
Mailing Address - Country:US
Mailing Address - Phone:678-904-7050
Mailing Address - Fax:678-904-7051
Practice Address - Street 1:5329 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3212
Practice Address - Country:US
Practice Address - Phone:678-904-7050
Practice Address - Fax:678-904-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-0872385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care