Basic Information
Provider Information | |||||||||
NPI: | 1003868803 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REMI VISTA INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 494100 | ||||||||
Address2: |   | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960494100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302455805 | ||||||||
FaxNumber: | 5302450340 | ||||||||
Practice Location | |||||||||
Address1: | 2500 FLORAL AVE | ||||||||
Address2: |   | ||||||||
City: | CHICO | ||||||||
State: | CA | ||||||||
PostalCode: | 959739143 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5308934784 | ||||||||
FaxNumber: | 5308936144 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2006 | ||||||||
LastUpdateDate: | 04/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MONSON | ||||||||
AuthorizedOfficialFirstName: | TRACEY | ||||||||
AuthorizedOfficialMiddleName: | JO | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 5302455808 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 045001629 | CA | N |   | Agencies | Case Management |   | 251C00000X |   |   | N |   | Agencies | Day Training, Developmentally Disabled Services |   | 253J00000X |   |   | N |   | Agencies | Foster Care Agency |   | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.