Provider Demographics
NPI:1790021137
Name:VISIONQUEST NATIONAL LTD.
Entity Type:Organization
Organization Name:VISIONQUEST NATIONAL LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
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:610-486-2280
Mailing Address - Street 1:600 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2102
Mailing Address - Country:US
Mailing Address - Phone:520-881-3950
Mailing Address - Fax:520-881-3269
Practice Address - Street 1:4521 KARNACK HWY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-8734
Practice Address - Country:US
Practice Address - Phone:903-938-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000000003245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000000Medicaid