Organization
VISION YOUTH GROUP HOME,INC.
Active
Other names
Northwest Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY GUESS MSW,LCSW (EXECUTIVE DIRECTOR)
(336) 508-2203
Entity
Organization
Contact information
Practice address
3415 COTTAGE PL, GREENSBORO, NC 27455-2019
(336) 288-7685
(336) 644-9254
Mailing address
6107 BASCOM DR, SUMMERFIELD, NC 27358-9119
(336) 508-2203
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-147
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603097
—
NC
Enumeration date
12/15/2006
Last updated
06/23/2008
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