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 |