1033711445 NPI number — THE VISIONAIRE CARE GROUP

Table of content: (NPI 1033711445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033711445 NPI number — THE VISIONAIRE CARE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VISIONAIRE CARE GROUP
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:
TRANSFORMING PAIN AND WELLNESS
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:
1033711445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 N GREEN VALLEY PKWY STE 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014-0408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-512-5800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N GREEN VALLEY PKWY STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-0408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-581-4711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIRTLE
Authorized Official First Name:
KEYSHONE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PROVIDER/OWNER
Authorized Official Telephone Number:
702-581-4711

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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