MEDICARE: NEW VISION MANAGEMENT GROUP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	0002086660	VA

General Provider Information

NPI Number	:	1881074557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION MANAGEMENT GROUP LLC

Provider Business Mailing Address
First Line	:	1812 LAKEVIEW AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5909
Country	:	US
Telephone Number	:	804-263-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 LAKEVIEW AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-5909
Country	:	US
Telephone Number	:	804-263-0540
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIMONE MITCHELL
Credential	:	QMHP, QMRP, LPN
Telephone Number	:	804-263-0540

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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