Provider Demographics
NPI:1063144624
Name:N.U. VISION
Entity type:Organization
Organization Name:N.U. VISION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:LA'DEA
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:678-993-5881
Mailing Address - Street 1:702 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1600
Mailing Address - Country:US
Mailing Address - Phone:678-993-5881
Mailing Address - Fax:
Practice Address - Street 1:702 JAMES ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-1600
Practice Address - Country:US
Practice Address - Phone:678-993-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness