Provider Demographics
NPI:1134206220
Name:INVISION CUSTOMIZED SERVICES
Entity type:Organization
Organization Name:INVISION CUSTOMIZED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIEGFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-933-5100
Mailing Address - Street 1:12450 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7387
Mailing Address - Country:US
Mailing Address - Phone:724-933-5100
Mailing Address - Fax:724-933-4076
Practice Address - Street 1:12450 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7387
Practice Address - Country:US
Practice Address - Phone:724-933-5100
Practice Address - Fax:724-933-4076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INVISION HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001898Medicaid