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General NPI Number Information
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NPI Number | 1225214760
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Entity Type | Organization
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Legal Business Name | VISION PERSONAL CARE HOME, INC.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 960 CURRY PL
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City | MACON
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State | GA
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Zip | 31211-1804
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Country | US
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Telephone | 478-750-4401
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Fax | 478-746-7774
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | MACON
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State | GA
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Zip | 31202-0518
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Country | US
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Telephone | 478-750-4401
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Fax | 478-746-7774
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | SHANDRIYEL MARIE BEN
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Credential |
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Telephone | 504-270-4439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 011-01-105-1
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License Number State | GA
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