Basic Information
| Provider Information | |||||||||
| NPI: | 1982234787 | ||||||||
| 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 NEWBURG | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072688722 | ||||||||
| FaxNumber: | 7072680218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2020 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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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: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.