Vista Maria

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

43 01 070436 Issued in MI

Legal business name

VISTA MARIA

Practice address

20651 W Warren Ave
Dearborn Heights, MI 48127-2622

Phone

(313) 271-3050

Fax

(313) 336-3460

NPI assigned

Oct 31, 2006

Last updated

Apr 7, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Earl Goddin

Title

Chief Financial Officer

Phone

(313) 271-3050

Specialties & licenses 4

Addresses

Other identifiers 4

Tax ID family

Program Manager2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Vista Maria Good Shepherd

  • Community/Behavioral Health Agency
  • Dearborn Heights, MI
  • NPI 1497928816
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Roberta Claudin, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Detroit, MI
  • NPI 1407238694
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1477639458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20651 W WARREN ST",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481272622",
            "telephone_number": "313-271-3050",
            "fax_number": "313-336-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20651 W WARREN AVE",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481272622",
            "telephone_number": "313-271-3050",
            "fax_number": "313-336-3460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA MARIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "GODDIN",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "313-271-3050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MI",
            "license": "43 01 052026",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MI",
            "license": "43 01 032319",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MI",
            "license": "43 01 070436",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MI",
            "license": "43 01 036786",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3241311",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4512114",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4652830",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4646898",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Venoy RX LLC (Heights Pharmacy)
• Matthew John Vertin, DDS
• Vida Clinical Studies
• Vinaya K. Gavini MDPC
• Visiting Doctors for America PC
• Vista Maria Good Shepherd
• Vitae Health Medical Michigan PLLC
• Vital Care Agency
• Vital Living Home Care LLC
• Vitality Health Clinic

• Emotionally Disturbed Childrens' Residential Treatment Facility in Dearborn Heights, MI
• Providers in Dearborn Heights, MI by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.