Provider Demographics
NPI:1578629978
Name:VISIONQUEST
Entity Type:Organization
Organization Name:VISIONQUEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - SERVICE DELIVERY
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSICA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-486-2280
Mailing Address - Street 1:150 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2632
Mailing Address - Country:US
Mailing Address - Phone:610-486-2280
Mailing Address - Fax:610-384-7258
Practice Address - Street 1:42660 HWY 441 NORTH
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-763-6019
Practice Address - Fax:863-357-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL070807100320800000X
FL070807102320800000X
FL0762075-00320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070807100Medicaid
FL070807102Medicaid
FL0762075-00Medicaid