Provider Demographics
NPI:1295880821
Name:RIO VISTA CARE, INC.
Entity type:Organization
Organization Name:RIO VISTA CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEJARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-374-5243
Mailing Address - Street 1:628 MONTEZUMA ST
Mailing Address - Street 2:P.O. BOX 576
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1622
Mailing Address - Country:US
Mailing Address - Phone:707-374-5243
Mailing Address - Fax:707-374-5381
Practice Address - Street 1:628 MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1622
Practice Address - Country:US
Practice Address - Phone:707-374-5243
Practice Address - Fax:707-374-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480012AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health