Provider Demographics
NPI:1801033220
Name:RECAPTURING THE VISION
Entity Type:Organization
Organization Name:RECAPTURING THE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-232-6003
Mailing Address - Street 1:9780 E INDIGO ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5610
Mailing Address - Country:US
Mailing Address - Phone:305-232-6003
Mailing Address - Fax:305-232-6092
Practice Address - Street 1:9780 E INDIGO ST STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5610
Practice Address - Country:US
Practice Address - Phone:305-232-6003
Practice Address - Fax:305-232-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD226601251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL914018200Medicaid