Provider Demographics
NPI:1124616479
Name:VISION QUEST RECOVERY HOUSING INC
Entity type:Organization
Organization Name:VISION QUEST RECOVERY HOUSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-300-8536
Mailing Address - Street 1:1902 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6238
Mailing Address - Country:US
Mailing Address - Phone:810-300-8536
Mailing Address - Fax:
Practice Address - Street 1:1218 LAPEER AVE # 1220
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4352
Practice Address - Country:US
Practice Address - Phone:810-300-8536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility