Bella Vista Resources
Social Worker, Clinical in Mesa, AZ. Organization (NPI-2).
NPI number1780979583
StatusActive
Last updated in NPPESJun 9, 2011
Details
- NPI
- 1780979583
- Entity type
- Organization (NPI-2)
- Legal business name
- Bella Vista Resources
- Organization subpart
- No
- Enumeration date
- Jun 9, 2011
- Last updated
- Jun 9, 2011
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | LCSW 12033 | AZ | Yes |
Practice location
5911 E Nance StMesa, AZ 85215-1485
Phone 480-305-3160
Mailing address
Po Box 22243Mesa, AZ 85277-2243
Phone 480-305-3160
Authorized official
Diana Marie Kyrisch
President
4803053160
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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