MEDICARE: A VISION OF CHOICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1417623232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A VISION OF CHOICE

Provider Business Mailing Address
First Line	:	PO BOX 331231
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76163-1231
Country	:	US
Telephone Number	:	817-849-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 PALM RIDGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-8316
Country	:	US
Telephone Number	:	817-849-4005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALLIE DENISE MITCHELL
Credential	:
Telephone Number	:	817-849-4005

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	03/29/2023

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Directions to “A VISION OF CHOICE ” Practice Location

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