=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699698076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3720 W GARRISON AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21215-5714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-205-3120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 CARDINAL CT
-----------------------------------------------------
City | ESSEX
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21221-5870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-205-3120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | MS. JUOCHI IWEALA
-----------------------------------------------------
Credential | CAC-AD
-----------------------------------------------------
Telephone | 410-205-3120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------