Provider Demographics
NPI:1275716045
Name:INVISION MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:INVISION MANAGEMENT CORPORATION
Other - Org Name:A SECOND CHANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MALT, BA
Authorized Official - Phone:443-460-2374
Mailing Address - Street 1:4852 US HIGHWAY 158
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-8948
Mailing Address - Country:US
Mailing Address - Phone:252-535-1192
Mailing Address - Fax:252-535-1147
Practice Address - Street 1:4852 US HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-8948
Practice Address - Country:US
Practice Address - Phone:252-535-1192
Practice Address - Fax:252-535-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL042039320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603561Medicaid
NCH63008Medicaid