Provider Demographics
NPI: | 1134800253 |
---|---|
Name: | VISIONS ADT OF NWF LLC |
Entity type: | Organization |
Organization Name: | VISIONS ADT OF NWF LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | THERESA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DANIELS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 850-693-0411 |
Mailing Address - Street 1: | 437 COE DAIRY RD |
Mailing Address - Street 2: | 3 |
Mailing Address - City: | DOTHAN |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36301 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-693-0411 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1613 MONROE SHEFFIELD RD # C |
Practice Address - Street 2: | |
Practice Address - City: | CHIPLEY |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32428-5719 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-693-0411 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-07-31 |
Last Update Date: | 2023-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 342000000X | Transportation Services | Transportation Network Company | |
No | 174200000X | Other Service Providers | Meals |