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
420 GULLEY ST, GOLDSBORO, NC 27530-5045
(336) 887-0708
(336) 887-1085
Mailing address
307 S SWING RD STE 5, GREENSBORO, NC 27409-2073
(336) 887-0708
(336) 887-1085
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL 041 179
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604062
—
NC
Enumeration date
06/27/2007
Last updated
07/26/2011
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