Provider Demographics
NPI:1841291002
Name:VISTA HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:VISTA HOME HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:JASTIA
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:661-267-0097
Mailing Address - Street 1:343 E PALMDALE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7138
Mailing Address - Country:US
Mailing Address - Phone:661-267-0097
Mailing Address - Fax:661-267-0096
Practice Address - Street 1:343 E PALMDALE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7138
Practice Address - Country:US
Practice Address - Phone:661-267-0097
Practice Address - Fax:661-267-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA980000877251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA980000877OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CAHHA57500FMedicaid