Healthcare Provider Details

I. General information

NPI: 1710184734
Provider Name (Legal Business Name): UNITED VISIONS HEALTHCARE II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 NASH ST S
WILSON NC
27893-3890
US

IV. Provider business mailing address

PO BOX 6421
ROCKY MOUNT NC
27802-6421
US

V. Phone/Fax

Practice location:
  • Phone: 252-206-1111
  • Fax: 252-237-1723
Mailing address:
  • Phone: 252-206-1111
  • Fax: 252-237-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC1584
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3418234
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MR. RAYMOND ALLEN STATON
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-206-1111