Provider Demographics
NPI:1699422535
Name:VISIONARY HEALTHCARE
Entity type:Organization
Organization Name:VISIONARY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOHESSY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-483-1149
Mailing Address - Street 1:101 LUCAS VALLEY RD # 317
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1791
Mailing Address - Country:US
Mailing Address - Phone:415-483-1149
Mailing Address - Fax:
Practice Address - Street 1:101 LUCAS VALLEY RD # 317
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1791
Practice Address - Country:US
Practice Address - Phone:415-483-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization