Healthcare Provider Details

I. General information

NPI: 1679267942
Provider Name (Legal Business Name): VISION WORLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E UNIVERSITY DR STE P7
MESA AZ
85203-8161
US

IV. Provider business mailing address

22280 S 209TH WAY APT 221
QUEEN CREEK AZ
85142-4954
US

V. Phone/Fax

Practice location:
  • Phone: 602-782-0216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. VALENA JORDAN
Title or Position: CEO
Credential:
Phone: 602-782-0216