Provider Demographics
NPI:1104658111
Name:PROFOUND VISIONZ ORGANIZATION LLC
Entity type:Organization
Organization Name:PROFOUND VISIONZ ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUMPEI
Authorized Official - Middle Name:TROIE
Authorized Official - Last Name:POLLARD-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-254-1884
Mailing Address - Street 1:2300 GARRISON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2308
Mailing Address - Country:US
Mailing Address - Phone:410-202-3760
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2308
Practice Address - Country:US
Practice Address - Phone:410-202-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)