Provider Demographics
NPI:1720483514
Name:ENVISIONCARE HEALTH SERVICES
Entity Type:Organization
Organization Name:ENVISIONCARE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEREESE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-245-1124
Mailing Address - Street 1:1600 TYSONS BLVD
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4865
Mailing Address - Country:US
Mailing Address - Phone:703-245-1124
Mailing Address - Fax:
Practice Address - Street 1:1600 TYSONS BLVD
Practice Address - Street 2:8TH FLOOR
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4865
Practice Address - Country:US
Practice Address - Phone:703-245-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care