Provider Demographics
NPI:1427452705
Name:VISIONS INTERPERSONAL SERVICES
Entity type:Organization
Organization Name:VISIONS INTERPERSONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-258-2086
Mailing Address - Street 1:5390 CAMBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4101
Mailing Address - Country:US
Mailing Address - Phone:248-862-5331
Mailing Address - Fax:
Practice Address - Street 1:5390 CAMBOURNE PL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4101
Practice Address - Country:US
Practice Address - Phone:248-862-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISIONS INTERPERSONAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health