=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568765261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW VISSION HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2010
-----------------------------------------------------
Last Update Date | 12/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5115 CHESHIRE LN
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-4165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-264-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7424 9TH ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20012-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-264-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. GLADYS FONTEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-264-0249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------