Organization
VISTA BEHAVIORAL LLC
Active
Other names
Vista Behavioral
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN MATTHEW DISIMONE (ACCOUNT MANAGER)
(973) 277-5359
Entity
Organization
Contact information
Practice address
18022 LAKE ENCINO DR, ENCINO, CA 91316-4428
(973) 277-5359
Mailing address
18022 LAKE ENCINO DR, ENCINO, CA 91316-4428
(973) 277-5359
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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