Provider Demographics
NPI:1881018232
Name:VISIONARY LIVING INC
Entity Type:Organization
Organization Name:VISIONARY LIVING INC
Other - Org Name:VISIONARY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:850-261-0713
Mailing Address - Street 1:PO BOX 36213
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32516-6213
Mailing Address - Country:US
Mailing Address - Phone:850-261-0713
Mailing Address - Fax:850-733-9910
Practice Address - Street 1:923 N 77TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-3704
Practice Address - Country:US
Practice Address - Phone:850-261-0713
Practice Address - Fax:850-733-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL60293104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness