=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831993757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER VISIONS COMMUNITY SUPPORT SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2025
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 TRUMAN RD
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-338-7821
-----------------------------------------------------
Fax | 757-338-7821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 TRUMAN RD
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-338-7821
-----------------------------------------------------
Fax | 757-338-7821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/EXECUTOR
-----------------------------------------------------
Name | DEBORAH MARIE OSBORNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-338-7821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------