Healthcare Provider Details

I. General information

NPI: 1619342136
Provider Name (Legal Business Name): VIZION HEALTH OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 A ST SW
MIAMI OK
74354-6806
US

IV. Provider business mailing address

10935 WINDS CROSSING DR SUITE 700
CHARLOTTE NC
28273-2402
US

V. Phone/Fax

Practice location:
  • Phone: 504-717-8614
  • Fax:
Mailing address:
  • Phone: 704-981-2161
  • Fax: 310-451-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK EDWIN SCHNEIDER
Title or Position: CEO
Credential:
Phone: 504-717-8614