Organization
VISION YOUTH GROUP HOME,INC.
Active
Other names
Banoyd 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
3705 ROCK HAVEN DR, GREENSBORO, NC 27410-3714
(336) 286-0036
(336) 644-9254
Mailing address
6107 BASCOM DR, SUMMERFIELD, NC 27358-9119
(336) 508-2203
(336) 644-9254
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-162
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603096
—
NC
Enumeration date
12/15/2006
Last updated
11/13/2008
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