1285647263 NPI number — VISIONQUEST NATIONAL LTD.

Table of content: (NPI 1285647263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285647263 NPI number — VISIONQUEST NATIONAL LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONQUEST NATIONAL LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285647263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 E BROADWAY BLVD STE 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-486-2280
Provider Business Mailing Address Fax Number:
520-881-3269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 CONCORD AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19802-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-661-1826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DERTOUZOS
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
610-486-2280

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  325980 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 137430 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)