Healthcare Provider Details

I. General information

NPI: 1265172902
Provider Name (Legal Business Name): VISIEN MINISTRIES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W ALLEGHENY AVE
PHILADELPHIA PA
19132-1420
US

IV. Provider business mailing address

150 N LINDENWOOD ST
PHILADELPHIA PA
19139-2624
US

V. Phone/Fax

Practice location:
  • Phone: 267-519-2172
  • Fax:
Mailing address:
  • Phone: 267-519-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMAL ROBERT VANN
Title or Position: CEO
Credential:
Phone: 215-909-1228