1881855393 NPI number — VISION QUEST INDUSTRIES, INC.

Table of content: (NPI 1881855393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881855393 NPI number — VISION QUEST INDUSTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION QUEST INDUSTRIES, 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:
Provider Other Organization Name Type Code:
6
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:
1881855393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3187 RED HILL AVE STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-3449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-261-3000
Provider Business Mailing Address Fax Number:
888-266-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 DECISION ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-8523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-261-3000
Provider Business Practice Location Address Fax Number:
888-266-6968
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUFF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
VICE PRESIDENT REIMBURSEMENT
Authorized Official Telephone Number:
949-794-3440

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  101923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 101923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME01875F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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