Provider Demographics
NPI:1669506697
Name:VISION HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:VISION HEALTH CENTER, LLC
Other - Org Name:FAMILY CHOICE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HATISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-777-8820
Mailing Address - Street 1:8815 UNIVERSITY EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4100
Mailing Address - Country:US
Mailing Address - Phone:704-837-4094
Mailing Address - Fax:704-921-3323
Practice Address - Street 1:8815 UNIVERSITY EAST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4100
Practice Address - Country:US
Practice Address - Phone:704-837-4094
Practice Address - Fax:704-921-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3533251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601594Medicaid