ENVISIONS OF LIFE LLC NPI 1104179555

NPI Information

NPI: 1104179555
Provider Name: ENVISIONS OF LIFE LLC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
5 CENTERVIEW DRIVE
SUITE 110
GREENSBORO, NC
ZIP 27407
Phone: (336) 887-0708
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ENVISIONS OF LIFE LLC is a psychiatric/mental health nurse practitioner in Greensboro, NC. ENVISIONS OF LIFE LLC NPI is 1104179555. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5 CENTERVIEW DRIVE
SUITE 110
GREENSBORO, NC
ZIP 27407-709
Phone: (336) 887-0708
Fax: (336) 887-1085

The provider's authorized official is Tomeko Michelle Moore .
The authorized official title is President and has the following contact phone number (336) 887-0708.

The enumeration date for this NPI number is 10/23/2012 and was last updated on 3/25/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	101YP2500X	Counselor	Professional	NORTH CAROLINA	No
2	251S00000X	Community/Behavioral Health		NORTH CAROLINA	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	6006285	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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