Organization
GIFTED VISIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANICKA PORTER (EXECUTIVE DIRECTOR)
(919) 803-9392
Entity
Organization
Contact information
Practice address
148 CARRIE DR, CLAYTON, NC 27527-5731
(919) 585-6130
(919) 585-6130
Mailing address
2532 MAYBROOK CROSSING DR, RALEIGH, NC 27610-3296
(919) 803-9392
(919) 585-6130
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-051-166
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-051-167
NC
Other
Enumeration date
09/16/2008
Last updated
09/23/2008
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