Provider Demographics
NPI:1891147476
Name:NEW VISION SUPPORT SERVICE AGENCY
Entity Type:Organization
Organization Name:NEW VISION SUPPORT SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WAKETA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:CRAPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-319-5983
Mailing Address - Street 1:1331 UNION AVE
Mailing Address - Street 2:SUITE 932
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3513
Mailing Address - Country:US
Mailing Address - Phone:901-319-5983
Mailing Address - Fax:
Practice Address - Street 1:1331 UNION AVE
Practice Address - Street 2:SUITE 932
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3513
Practice Address - Country:US
Practice Address - Phone:901-319-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service