MEDICARE: INVISION CUSTOMIZED SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084P0800X	Psychiatry Physician
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	2084P0805X	Geriatric Psychiatry Physician
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134206220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVISION CUSTOMIZED SERVICES

Provider Business Mailing Address
First Line	:	12450 PERRY HWY
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7387
Country	:	US
Telephone Number	:	724-933-5100
Fax Number	:	724-933-4076

Provider Business Practice Location Address
First Line	:	12450 PERRY HWY
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7387
Country	:	US
Telephone Number	:	724-933-5100
Fax Number	:	724-933-4076

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RUTH E SIEGFRIED
Credential	:
Telephone Number	:	724-933-5100

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/28/2016

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Directions to “INVISION CUSTOMIZED SERVICES ” Practice Location

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