Provider Demographics
NPI:1831898253
Name:VISTA HEALTH CARE SOLUTION
Entity type:Organization
Organization Name:VISTA HEALTH CARE SOLUTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABILA
Authorized Official - Middle Name:PRIMUS
Authorized Official - Last Name:BENAZEA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:781-521-0302
Mailing Address - Street 1:9 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1027
Mailing Address - Country:US
Mailing Address - Phone:781-521-0302
Mailing Address - Fax:
Practice Address - Street 1:84 HIGHLAND AVE STE 304
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2733
Practice Address - Country:US
Practice Address - Phone:781-521-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA279930OtherLICENSE NUMBER