Provider Demographics
NPI:1477865624
Name:ADULT VISIONARY IN-HOME CARE, INC.
Entity Type:Organization
Organization Name:ADULT VISIONARY IN-HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-570-9051
Mailing Address - Street 1:7220 N LINDBERGH BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2019
Mailing Address - Country:US
Mailing Address - Phone:314-656-1411
Mailing Address - Fax:314-656-1540
Practice Address - Street 1:7220 N LINDBERGH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2019
Practice Address - Country:US
Practice Address - Phone:314-656-1411
Practice Address - Fax:314-656-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care