Basic Information
| Provider Information | |||||||||
| NPI: | 1508479643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REMI VISTA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 494100 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960494100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302455805 | ||||||||
| FaxNumber: | 5302450340 | ||||||||
| Practice Location | |||||||||
| Address1: | 10387 PORTA DEGO WAY | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960039289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302244716 | ||||||||
| FaxNumber: | 5302247168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | MONSON | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING/CONTRACTS ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5302455808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REMI VISTA, INC. | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 251B00000X | N | Agencies | Case Management | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 322D00000X | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.