=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083901458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NVISIONS IN-HOME SUPPORT SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 07/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14706 DELANO DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22193-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-285-5300
-----------------------------------------------------
Fax | 571-285-5300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14706 DELANO DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22193-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-285-5300
-----------------------------------------------------
Fax | 571-285-5300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / CEO
-----------------------------------------------------
Name | MS. MILLIE M JOYNER
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 571-268-2124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------