1104871532 NPI number — VISTACARE USA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104871532 NPI number — VISTACARE USA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTACARE USA, 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:
Provider Other Organization Name Type Code:
6
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:
1104871532
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:
4800 N SCOTTSDALE RD
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-7630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-648-4545
Provider Business Mailing Address Fax Number:
480-648-4550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1713 DAWSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31707-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-430-7537
Provider Business Practice Location Address Fax Number:
229-430-9846
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLAGER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
480-648-4545

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  047-223-H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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