Provider Demographics
NPI:1821563586
Name:VISIONS OF HUE, LLC
Entity Type:Organization
Organization Name:VISIONS OF HUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PREMPEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-332-6699
Mailing Address - Street 1:11826 W LUPINE AVE
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5050
Mailing Address - Country:US
Mailing Address - Phone:602-332-6699
Mailing Address - Fax:623-500-5372
Practice Address - Street 1:15213 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2997
Practice Address - Country:US
Practice Address - Phone:602-332-6699
Practice Address - Fax:623-500-5372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISIONS OF HUE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid