=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265172902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISIEN MINISTRIES LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2022
-----------------------------------------------------
Last Update Date | 03/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2233 W ALLEGHENY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19132-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-519-2172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 N LINDENWOOD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19139-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-519-2172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JAMAL ROBERT VANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-909-1228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------