Provider Demographics
NPI:1205514981
Name:PURPOSE OF VISION ADULT AND YOUTH ENRICHMENT CENTER
Entity type:Organization
Organization Name:PURPOSE OF VISION ADULT AND YOUTH ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-768-8282
Mailing Address - Street 1:11041 SHADOW CREEK PKWY STE 121
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7405
Mailing Address - Country:US
Mailing Address - Phone:832-768-8282
Mailing Address - Fax:
Practice Address - Street 1:440 BENMAR DR STE 1045
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3128
Practice Address - Country:US
Practice Address - Phone:832-768-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health