Provider Demographics
NPI:1801127139
Name:SISTAS OF VISION INC.
Entity type:Organization
Organization Name:SISTAS OF VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTIVE CARE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-921-5837
Mailing Address - Street 1:1750 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2904
Mailing Address - Country:US
Mailing Address - Phone:215-921-5837
Mailing Address - Fax:
Practice Address - Street 1:1750 N 25TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2904
Practice Address - Country:US
Practice Address - Phone:215-921-5837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32E5D7B6F3634C0CB2BE253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care