Provider Demographics
NPI:1528584109
Name:VISIONQUEST NATIONAL LTD
Entity Type:Organization
Organization Name:VISIONQUEST NATIONAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERTOUZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-486-2280
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-0472
Mailing Address - Country:US
Mailing Address - Phone:610-486-2280
Mailing Address - Fax:
Practice Address - Street 1:1800 NE LOOP 410 STE 214
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5210
Practice Address - Country:US
Practice Address - Phone:210-824-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health