Basic Information
| Provider Information | |||||||||
| NPI: | 1861904815 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| 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: | 3109 H ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302455805 | ||||||||
| FaxNumber: | 5302450340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2017 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | MONSON | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5302455805 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REMI VISTA INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.