| Vista Care Wisconsin Inc. | |
|
708 Erie Ave Ste 201 Sheboygan WI 53081-4060 | |
| (920) 457-0826 | |
| (920) 457-2207 |
| Full Name | Vista Care Wisconsin Inc. |
|---|---|
| Speciality | Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Location | 708 Erie Ave Ste 201, Sheboygan, Wisconsin |
| Authorized Official Name and Position | Timothy A. Frey (PRESIDENT) |
| Authorized Official Contact | 9204570826 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Care Wisconsin Inc. 708 Erie Ave Ste 201 Sheboygan WI 53081-4060 Ph: (920) 457-0826 | Vista Care Wisconsin Inc. 708 Erie Ave Ste 201 Sheboygan WI 53081-4060 Ph: (920) 457-0826 |
| NPI Number | 1902085624 |
|---|---|
| Provider Enumeration Date | 10/30/2007 |
| Last Update Date | 12/27/2023 |
| Certification Date | 12/18/2023 |
| Medicare PECOS PAC ID | 5092152579 |
|---|---|
| Medicare Enrollment ID | O20240319003766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902085624 | NPI | - | NPPES |
| Provider Name | Austin D Lucas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154869212 PECOS PAC ID: 5890035422 Enrollment ID: I20190319001288 |
| Provider Name | Evan Meyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487420964 PECOS PAC ID: 1153768635 Enrollment ID: I20240319003872 |
| Provider Name | Lindsay Connon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811474604 PECOS PAC ID: 4880032556 Enrollment ID: I20240401003262 |
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