# VISTA MARIA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477639458
- **Authorized official:** MR. EARL GODDIN (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (313) 271-3050

## Contact information

- **Practice address:** 20651 W WARREN AVE, DEARBORN HEIGHTS, MI 48127-2622
- **Practice address phone:** (313) 271-3050
- **Practice address fax:** (313) 336-3460
- **Mailing address:** 20651 W WARREN ST, DEARBORN HEIGHTS, MI 48127-2622
- **Mailing address phone:** (313) 271-3050
- **Mailing address fax:** (313) 336-3460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 43 01 032319 | MI | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 43 01 036786 | MI | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 43 01 052026 | MI | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 43 01 070436 | MI | Yes |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 04/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3241311 | — | MI |
| 05 | — | 4512114 | — | MI |
| 05 | — | 4646898 | — | MI |
| 05 | — | 4652830 | — | MI |