NPIMap

Organization Active NPI

WTB New Vision Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Winston Salem, NC
National Provider Identifier
1982783049
Registry record updated Jun 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-034-170 Issued in NC
Legal business name
WTB NEW VISION INC.
Practice address
102 W 3Rd St
Suite 502
Winston Salem, NC 27101-3940
Phone
(336) 723-7707
Fax
(336) 723-7708
NPI assigned
Nov 2, 2006
Last updated
Jun 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Authorized official

Name
Mr. Brian Hairston
Title
Executive Director
Phone
(336) 723-7707

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-034-185 NC
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-034-170 NC Primary
Mental Health Counselor 101YM0800X NU

Addresses

Primary practice location

102 W 3Rd St
Suite 502
Winston Salem, NC 27101-3940

Mailing address

102 W 3Rd St
Suite 502
Winston Salem, NC 27101-3987
Phone (336) 723-7707

Other identifiers 6

IdentifierTypeStateIssuer
6604170MedicaidNC
6603924MedicaidNC
6603536MedicaidNC
8300791MedicaidNC
8300791BMedicaidNC
8300791GMedicaidNC

National Provider Directory

National Provider Directory

Locations

102 W 3rd St
Ste 502
Winston Salem, NC 27101
Phone (336) 723-7707

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1982783049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W 3RD ST",
            "address_2": "SUITE 502",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013987",
            "telephone_number": "336-723-7707",
            "fax_number": "336-723-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W 3RD ST",
            "address_2": "SUITE 502",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013940",
            "telephone_number": "336-723-7707",
            "fax_number": "336-723-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WTB NEW VISION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-723-7707",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-034-185",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-034-170",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604170",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603924",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603536",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300791",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300791B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300791G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; 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.