MEDICARE: NEW VISION PROFESSIONAL SERVICES LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1659856516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION PROFESSIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2554 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3058
Country	:	US
Telephone Number	:	719-634-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2554 PALMER PARK BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3058
Country	:	US
Telephone Number	:	719-634-1851
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. REBECCA SHIELDS
Credential	:
Telephone Number	:	719-634-1851

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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