Provider Demographics
NPI:1679295448
Name:VISTA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:VISTA HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHORO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:302-299-3996
Mailing Address - Street 1:590 NAAMANS RD STE 219
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2308
Mailing Address - Country:US
Mailing Address - Phone:302-299-3996
Mailing Address - Fax:302-724-4795
Practice Address - Street 1:590 NAAMANS RD STE 219
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2308
Practice Address - Country:US
Practice Address - Phone:302-299-3996
Practice Address - Fax:302-724-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty