Provider Demographics
NPI:1114744026
Name:VISTA HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:VISTA HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-678-0459
Mailing Address - Street 1:8690 RUSHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9164
Mailing Address - Country:US
Mailing Address - Phone:734-678-0459
Mailing Address - Fax:
Practice Address - Street 1:8690 RUSHSIDE DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9164
Practice Address - Country:US
Practice Address - Phone:734-678-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care