Provider Demographics
NPI:1255032496
Name:BALANCED VISION LLC
Entity type:Organization
Organization Name:BALANCED VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUANQUILLA
Authorized Official - Middle Name:MONTESSA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:APSW
Authorized Official - Phone:262-672-1501
Mailing Address - Street 1:500 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1060
Mailing Address - Country:US
Mailing Address - Phone:262-672-1501
Mailing Address - Fax:
Practice Address - Street 1:500 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1060
Practice Address - Country:US
Practice Address - Phone:262-672-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health