Healthcare Provider Details

I. General information

NPI: 1366984627
Provider Name (Legal Business Name): GREATER VISION HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 MONTGOMERY AVE STE 200
OCOEE FL
34761-3102
US

IV. Provider business mailing address

788 MONTGOMERY AVE STE 200
OCOEE FL
34761-3102
US

V. Phone/Fax

Practice location:
  • Phone: 407-473-2837
  • Fax: 407-614-2420
Mailing address:
  • Phone: 407-473-2837
  • Fax: 407-614-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VERNET STALLWORTH
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 407-473-2837