Provider Demographics
NPI:1326086729
Name:DYNAMIC VISIONS, INC.
Entity Type:Organization
Organization Name:DYNAMIC VISIONS, INC.
Other - Org Name:DYNAMIC VISIONS HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARKETING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:POUFONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-725-0020
Mailing Address - Street 1:18 TREMONT ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2301
Mailing Address - Country:US
Mailing Address - Phone:617-725-0020
Mailing Address - Fax:617-725-0027
Practice Address - Street 1:18 TREMONT ST
Practice Address - Street 2:SUITE 143
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2301
Practice Address - Country:US
Practice Address - Phone:617-725-0020
Practice Address - Fax:617-725-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0608521Medicaid
MA227502Medicare Oscar/Certification