Provider Demographics
NPI:1215276357
Name:VISION OF FAITH OUTRREACH INC
Entity type:Organization
Organization Name:VISION OF FAITH OUTRREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CROSSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-885-8516
Mailing Address - Street 1:582 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3920
Mailing Address - Country:US
Mailing Address - Phone:877-885-8516
Mailing Address - Fax:860-224-0675
Practice Address - Street 1:582 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3920
Practice Address - Country:US
Practice Address - Phone:877-885-8516
Practice Address - Fax:860-224-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-09
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT490636670-001Medicaid