MEDICARE: VISIONS RESIDENTIAL HEALTHCARE SERVICES

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-026-700	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982781993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONS RESIDENTIAL HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	549 STACY WEAVER DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-0859
Country	:	US
Telephone Number	:	910-482-3513
Fax Number	:	910-482-3571

Provider Business Practice Location Address
First Line	:	1398 MCARTHUR RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1203
Country	:	US
Telephone Number	:	910-482-3496
Fax Number	:	910-482-3571

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MS. ANNIE R. HASAN
Credential	:	M.ED.
Telephone Number	:	910-482-3513

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/03/2008

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