Organization
VISTA ADULT SERVICES ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BOUDER (CHIEF OPERATING OFFICER)
(717) 583-5102
Entity
Organization
Contact information
Practice address
24 NORTHEAST DR, HERSHEY, PA 17033-2732
(717) 835-1115
Mailing address
24 NORTHEAST DR, HERSHEY, PA 17033-2732
(717) 835-1115
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
PA
Enumeration date
02/21/2014
Last updated
09/16/2015
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