Provider Demographics
NPI:1326462334
Name:INNER-VISION EDUCATION CENTER, LLC
Entity Type:Organization
Organization Name:INNER-VISION EDUCATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-794-1573
Mailing Address - Street 1:1572 STANDING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-8051
Mailing Address - Country:US
Mailing Address - Phone:804-794-1573
Mailing Address - Fax:804-414-7026
Practice Address - Street 1:1572 STANDING RIDGE DR
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8051
Practice Address - Country:US
Practice Address - Phone:804-794-1573
Practice Address - Fax:804-414-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA199102006320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities