1760710354 NPI number — VISION HEALTHCARE SERVICES, INC

Table of content: (NPI 1760710354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760710354 NPI number — VISION HEALTHCARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION HEALTHCARE SERVICES, INC
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:
ALPHA VISION HOMECARE
Provider Other Organization Name Type Code:
3
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:
1760710354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4113 LINGLESTOWN RD
Provider Second Line Business Mailing Address:
SUITE 100A
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17112-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-545-6637
Provider Business Mailing Address Fax Number:
717-545-8083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4113 LINGLESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17112-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-545-6637
Provider Business Practice Location Address Fax Number:
717-545-8083
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
UMANA
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
717-545-6637

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  04010501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 04010501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X , with the licence number: 04010501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04010501 . This is a "HOME HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 04010501 . This is a "DEPARTMENT OF HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011012070001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21233601 . This is a "HOMECARE AGENCY & REGISTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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