Provider Demographics
NPI:1548418486
Name:VISIONARY HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:VISIONARY HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOMPOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-270-0213
Mailing Address - Street 1:1266 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1344
Mailing Address - Country:US
Mailing Address - Phone:973-270-0213
Mailing Address - Fax:973-773-2722
Practice Address - Street 1:1266 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1344
Practice Address - Country:US
Practice Address - Phone:973-270-0213
Practice Address - Fax:973-773-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0115000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health