Provider Demographics
NPI:1225214760
Name:VISION PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:VISION PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANDRIYEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-270-4439
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31202-0518
Mailing Address - Country:US
Mailing Address - Phone:478-750-4401
Mailing Address - Fax:478-746-7774
Practice Address - Street 1:960 CURRY PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1804
Practice Address - Country:US
Practice Address - Phone:478-750-4401
Practice Address - Fax:478-746-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-01-105-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center