NPIMap

Organization Active NPI

Envisions of Life, LLC

  • Case Management Agency
  • Greensboro, NC
National Provider Identifier
1255538039
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
ENVISIONS OF LIFE, LLC
Practice address
4003 Gatwick CT
Greensboro, NC 27406-8573
Phone
(336) 697-5277
Fax
(336) 697-3156
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tomeko Michelle Moore
Title
President
Phone
(336) 887-0708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NC Primary

Addresses

Primary practice location

4003 Gatwick CT
Greensboro, NC 27406-8573

Mailing address

204 Kelly PL
High Point, NC 27262-2609
Phone (336) 887-0708

Other identifiers 5

IdentifierTypeStateIssuer
8300636MedicaidNC
8300636AMedicaidNC
8300636GMedicaidNC
8300636BMedicaidNC
8300636HMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Envisions of Life LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255538039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 KELLY PL",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272622609",
            "telephone_number": "336-887-0708",
            "fax_number": "336-887-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 GATWICK CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068573",
            "telephone_number": "336-697-5277",
            "fax_number": "336-697-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISIONS OF LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TOMEKO",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-887-0708",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300636",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300636A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300636G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300636B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300636H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.