Healthcare Provider Details

I. General information

NPI: 1427452705
Provider Name (Legal Business Name): VISIONS INTERPERSONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5390 CAMBOURNE PL
WEST BLOOMFIELD MI
48322-4101
US

IV. Provider business mailing address

5390 CAMBOURNE PL
WEST BLOOMFIELD MI
48322-4101
US

V. Phone/Fax

Practice location:
  • Phone: 248-862-5331
  • Fax:
Mailing address:
  • Phone: 248-862-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. CONSTANCE GWYNN
Title or Position: CEO/OWNER
Credential: LMSW
Phone: 313-258-2086