Provider Demographics
NPI:1649422544
Name:VISION HOUSE COMMUNITY OUTREACH SERVICES
Entity Type:Organization
Organization Name:VISION HOUSE COMMUNITY OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-624-1200
Mailing Address - Street 1:5599 US 220 ALT
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NC
Mailing Address - Zip Code:27229
Mailing Address - Country:US
Mailing Address - Phone:336-624-1200
Mailing Address - Fax:
Practice Address - Street 1:5599 US 220 ALT
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NC
Practice Address - Zip Code:27229
Practice Address - Country:US
Practice Address - Phone:336-624-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health