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General NPI Number Information
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NPI Number | 1124616479
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Entity Type | Organization
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Legal Business Name | VISION QUEST RECOVERY HOUSING INC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 1218 LAPEER AVE # 1220
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City | PORT HURON
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State | MI
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Zip | 48060-4352
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Country | US
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Telephone | 810-300-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 13TH ST
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City | PORT HURON
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State | MI
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Zip | 48060-6238
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Country | US
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Telephone | 810-300-8536
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN KROLL
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Credential |
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Telephone | 810-300-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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