MEDICARE: NEW VISION LIVING, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1801426184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION LIVING, LLC

Provider Business Mailing Address
First Line	:	10314 GREENTRAIL DR N
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4410
Country	:	US
Telephone Number	:	561-715-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	1184 SW 27TH PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7832
Country	:	US
Telephone Number	:	561-715-0548
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID A COX
Credential	:
Telephone Number	:	561-715-0548

Provider Enumeration Date	:	01/25/2020
Last Update Date	:	01/25/2020

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