Organization
VISTA CARE SOUTH DAKOTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY ALAN FREY (PRESIDENT)
(920) 694-1102
Entity
Organization
Contact information
Practice address
708 ERIE AVE, SHEBOYGAN, WI 53081-4060
(920) 694-1102
(920) 694-4685
Mailing address
708 ERIE AVE, SHEBOYGAN, WI 53081-4060
(920) 694-1102
(920) 694-4685
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/10/2019
Last updated
05/01/2023
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