Provider Demographics
NPI:1962632653
Name:VISTA HILL
Entity Type:Organization
Organization Name:VISTA HILL
Other - Org Name:INCREDIBLE FAMILIES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-668-4200
Mailing Address - Street 1:4990 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7409
Mailing Address - Country:US
Mailing Address - Phone:619-668-4200
Mailing Address - Fax:619-698-1665
Practice Address - Street 1:4990 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7409
Practice Address - Country:US
Practice Address - Phone:619-668-4200
Practice Address - Fax:619-698-1665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA008840251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health