Vista Care South Dakota, LLC

NPI #1124586037 in Sheboygan, Wisconsin

Provider Information

NPI Number: 1124586037
Entity Type: Organization
Organization Name: Vista Care South Dakota, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 10, 2019
Last Updated: May 1, 2023

Practice Location

Address: 708 ERIE AVE
City: Sheboygan
State: Wisconsin
ZIP Code: 53081-4060
Phone: (920) 694-1102

Authorized Official

Name: MR. TIMOTHY ALAN FREY
Title: PRESIDENT
Phone: (920) 694-1102

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
In Home Supportive Care	253Z00000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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