NPIMap

Organization Active NPI

Envisions of Life, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Greensboro, NC
National Provider Identifier
1881891695
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
041-699 Issued in NC
Legal business name
ENVISIONS OF LIFE, LLC
Practice address
4003 Gatwick CT
Greensboro, NC 27406-8573
Phone
(336) 697-5277
Fax
(336) 887-1085
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Authorized official

Name
Mrs. Tomeko Moore, LCAS, LCSWA
Title
President
Phone
(336) 887-0708

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 041-699 NC Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL 041 699 NC

Addresses

Primary practice location

4003 Gatwick CT
Greensboro, NC 27406-8573

Mailing address

5 Centerview Dr.
Ste 110
Greensboro, NC 27407-3709
Phone (336) 887-0708

Other identifiers 1

IdentifierTypeStateIssuer
6603624MedicaidNC

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": "1488931200000",
    "number": "1881891695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CENTERVIEW DR.",
            "address_2": "STE 110",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073709",
            "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": "336-887-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISIONS OF LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TOMEKO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-887-0708",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCAS, LCSWA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "041-699",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL 041 699",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603624",
            "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 Mar 8, 2017; 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.