1518097799 NPI number — VISTA GUIDANCE CENTERS, INC.

Table of content: (NPI 1518097799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518097799 NPI number — VISTA GUIDANCE CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA GUIDANCE CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REDLAND YUCAIPA GUIDANCE CENTERS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518097799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92375-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-7067
Provider Business Mailing Address Fax Number:
909-792-2045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15447 ANACAPA RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92392-2481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-245-9446
Provider Business Practice Location Address Fax Number:
760-951-8986
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORJA
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
JENNY
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
909-335-7067

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  360023EN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36AD , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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