Provider Demographics
NPI:1992708473
Name:VISTACARE HEALTH SERVICES, INC
Entity type:Organization
Organization Name:VISTACARE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-373-8831
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:TN
Mailing Address - Zip Code:38014-0277
Mailing Address - Country:US
Mailing Address - Phone:901-373-8831
Mailing Address - Fax:901-373-7655
Practice Address - Street 1:8813 CHAFFEE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:TN
Practice Address - Zip Code:38014-0000
Practice Address - Country:US
Practice Address - Phone:901-373-8831
Practice Address - Fax:901-373-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000612332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000000612OtherDME LICENSE
TN1452522Medicaid
TN3144888OtherBLUE CROSS BLUE SHIELD
TN1309690001Medicare NSC