1619002631 NPI number — VISIONS OF CARE

Table of content: (NPI 1619002631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619002631 NPI number — VISIONS OF CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONS OF CARE
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:
1619002631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 MCCULLOUGH DR
Provider Second Line Business Mailing Address:
SUITE125
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-4385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-547-1900
Provider Business Mailing Address Fax Number:
704-547-1937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 MCCULLOUGH DR
Provider Second Line Business Practice Location Address:
SUITE105
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-4385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-547-1900
Provider Business Practice Location Address Fax Number:
704-547-1937
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAHOON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
FOLTZ
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
704-906-8893

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6102034 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 8300220 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6102034 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 8300220 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 8300220 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6102034 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300220 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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