Provider Demographics
NPI:1568611440
Name:GIFTED VISIONS LLC
Entity Type:Organization
Organization Name:GIFTED VISIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-803-9392
Mailing Address - Street 1:2532 MAYBROOK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3296
Mailing Address - Country:US
Mailing Address - Phone:919-803-9392
Mailing Address - Fax:919-585-6130
Practice Address - Street 1:148 CARRIE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-5731
Practice Address - Country:US
Practice Address - Phone:919-585-6130
Practice Address - Fax:919-585-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-167322D00000X
NCMHL-051-166322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children