Provider Demographics
NPI:1801653514
Name:MANIFESTED VISIONS LLC
Entity type:Organization
Organization Name:MANIFESTED VISIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDUSUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-941-9742
Mailing Address - Street 1:305 FM 517 RD E UNIT B
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8643
Mailing Address - Country:US
Mailing Address - Phone:409-941-9742
Mailing Address - Fax:
Practice Address - Street 1:305 FM 517 RD E UNIT B
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8643
Practice Address - Country:US
Practice Address - Phone:409-941-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty