Provider Demographics
NPI:1962689463
Name:VISIONS RESIDENTIAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:VISIONS RESIDENTIAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, QMHP
Authorized Official - Phone:910-624-6513
Mailing Address - Street 1:PO BOX 9729
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9091
Mailing Address - Country:US
Mailing Address - Phone:910-482-4453
Mailing Address - Fax:910-482-3571
Practice Address - Street 1:549 STACY WEAVER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-0859
Practice Address - Country:US
Practice Address - Phone:910-482-4453
Practice Address - Fax:910-482-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 063-061322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300349BMedicaid