Provider Demographics
NPI:1104871532
Name:VISTACARE USA, INC.
Entity type:Organization
Organization Name:VISTACARE USA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-648-4545
Mailing Address - Street 1:4800 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:480-648-4545
Mailing Address - Fax:480-648-4550
Practice Address - Street 1:1713 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3301
Practice Address - Country:US
Practice Address - Phone:229-430-7537
Practice Address - Fax:229-430-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-223-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111619Medicare ID - Type Unspecified