Organization
ENVISIONS OF LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TOMEKO MICHELLE MOORE (PRESIDENT)
(336) 887-0708
Entity
Organization
Contact information
Practice address
4003 GATWICK CT, GREENSBORO, NC 27406-8573
(336) 697-5277
(336) 697-3156
Mailing address
204 KELLY PL, HIGH POINT, NC 27262-2609
(336) 887-0708
(336) 887-1085
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300636
—
NC
05
—
8300636A
—
NC
05
—
8300636B
—
NC
05
—
8300636G
—
NC
05
—
8300636H
—
NC
Enumeration date
06/27/2007
Last updated
08/22/2020
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