Provider Demographics
NPI:1891983540
Name:ENVISIONARY I-CARE
Entity Type:Organization
Organization Name:ENVISIONARY I-CARE
Other - Org Name:HOME CARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-661-2338
Mailing Address - Street 1:PO BOX 2222
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2222
Mailing Address - Country:US
Mailing Address - Phone:919-661-2338
Mailing Address - Fax:919-661-7464
Practice Address - Street 1:133 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3942
Practice Address - Country:US
Practice Address - Phone:919-661-2338
Practice Address - Fax:919-661-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601334Medicaid