Healthcare Provider Details

I. General information

NPI: 1134800253
Provider Name (Legal Business Name): VISIONS ADT OF NWF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 MONROE SHEFFIELD RD # C
CHIPLEY FL
32428-5719
US

IV. Provider business mailing address

437 COE DAIRY RD 3
DOTHAN AL
36301
US

V. Phone/Fax

Practice location:
  • Phone: 850-693-0411
  • Fax:
Mailing address:
  • Phone: 850-693-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: MS. THERESA DANIELS
Title or Position: CO-OWNER
Credential:
Phone: 850-693-0411