VISTA MARIA
NPI 1477639458
Residential Treatment Facility, Emotionally Disturbed Children in Dearborn Heights, MI
- Organization
- Residential Treatment Facility, Emotiona...
- CLIA Number: 23D2028349
- CLIA Cert. Type: Other - TREATMENT FACILITY BEHAV
- CLIA Exp. Date: 08-14-2027
About VISTA MARIA
This page provides the complete NPI Profile along with additional information for Vista Maria, a provider established in Dearborn Heights, Michigan operating as a Residential Treatment Facility, Emotionally Disturbed Children. The healthcare provider is registered in the NPI registry with number 1477639458 assigned on October 2006. The practitioner's primary taxonomy code is 322D00000X with license number 43 01 070436 (MI). The provider is registered as an organization and their NPI record was last updated 18 years ago. The authorized official of this NPI record is Mr. Earl Goddin (Chief Financial Officer)
- NPI
- 1477639458 Verify this NPI
- Provider Name
- VISTA MARIA
- Entity Type
- Organization
- Location Address
- 20651 W WARREN AVE DEARBORN HEIGHTS, MI 48127
- Location Phone
- (313) 271-3050
- Location Fax
- (313) 336-3460
- Mailing Address
- 20651 W WARREN ST DEARBORN HEIGHTS, MI 48127
- Mailing Phone
- (313) 271-3050
- Mailing Fax
- (313) 336-3460
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-31-2006
- Last Update Date
- 04-07-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Residential Treatment Facility, Emotionally Disturbed Children
- Taxonomy Code
- 322D00000X
- Type
- Residential Treatment Facilities
- License No.
- 43 01 070436
- License State
- MI
- Taxonomy Description
- A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 43 01 036786 (MI) |
| 2 | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 43 01 052026 (MI) |
| 3 | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 43 01 032319 (MI) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 4646898 | MEDICAID (05) | MI | |
| 4512114 | MEDICAID (05) | MI | |
| 4652830 | MEDICAID (05) | MI | |
| 3241311 | MEDICAID (05) | MI |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D2028349
- Facility Type
- Other - TREATMENT FACILITY BEHAV
- Certificate Effective Date
- August 15, 2025
- Certificate Expiration Date
- August 14, 2027
- Laboratory Director
- ALICE M. MALINOWSKI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Vista Maria to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1477639458, enumerated as an "organization" on October 31, 2006.
The provider is located at 20651 W WARREN AVE DEARBORN HEIGHTS, MI 48127 and the phone number is (313) 271-3050.
Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
