Provider Demographics
NPI:1336519768
Name:VISIONARY FAMILY LIVING
Entity type:Organization
Organization Name:VISIONARY FAMILY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DETOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-907-1343
Mailing Address - Street 1:35498 SOMERSET RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-2159
Mailing Address - Country:US
Mailing Address - Phone:540-907-1343
Mailing Address - Fax:
Practice Address - Street 1:35498 SOMERSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2159
Practice Address - Country:US
Practice Address - Phone:540-907-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency