=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962246298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION HOUSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2024
-----------------------------------------------------
Last Update Date | 06/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1472 E 26TH AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43211-1671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-432-0887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1649 MCNAUGHTEN RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-432-0887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATION MANAGER
-----------------------------------------------------
Name | HAFTU ASAMEREW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-432-0887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------