Basic Information
| Provider Information | |||||||||
| NPI: | 1508095027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIZION ONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1237 GALLATIN ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025450211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1237 GALLATIN ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025450211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | KITWARA | ||||||||
| AuthorizedOfficialFirstName: | ABDALLAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2025450211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | NSA-0125 | DC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 039252900 | 05 | DC | MEDICAID |