Provider Demographics
NPI:1497533426
Name:NEW VISION OUTREACH CENTER INC
Entity Type:Organization
Organization Name:NEW VISION OUTREACH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-317-2421
Mailing Address - Street 1:3070 N MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2756
Mailing Address - Country:US
Mailing Address - Phone:770-317-2421
Mailing Address - Fax:
Practice Address - Street 1:3070 N MAIN ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2756
Practice Address - Country:US
Practice Address - Phone:770-317-2421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable