Provider Demographics
NPI:1114051950
Name:VISIONS CARE ADULT DAY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:VISIONS CARE ADULT DAY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-306-5004
Mailing Address - Street 1:4910 JONESBORO RD
Mailing Address - Street 2:BLDG 200
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2085
Mailing Address - Country:US
Mailing Address - Phone:770-306-5004
Mailing Address - Fax:770-306-7970
Practice Address - Street 1:4910 JONESBORO RD
Practice Address - Street 2:BLDG 200
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2085
Practice Address - Country:US
Practice Address - Phone:770-306-5004
Practice Address - Fax:770-306-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA604196354BOtherSOURCE
GA604196354AOtherCCSP
GA604196354DOtherCOMP
GA604196354COtherNOW WAIVER