Organization
ENVISIONS OF LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TOMEKO MOORE LCAS, LCSWA (PRESIDENT)
(336) 887-0708
Entity
Organization
Contact information
Practice address
4003 GATWICK CT, GREENSBORO, NC 27406-8573
(336) 697-5277
(336) 887-1085
Mailing address
5 CENTERVIEW DR., STE 110, GREENSBORO, NC 27407-3709
(336) 887-0708
(336) 887-1085
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
041-699
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL 041 699
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603624
—
NC
Enumeration date
06/27/2007
Last updated
03/08/2017
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