Provider Demographics
NPI:1912145293
Name:VISIONS OF NORTH CAROLINA INC
Entity Type:Organization
Organization Name:VISIONS OF NORTH CAROLINA INC
Other - Org Name:VISIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOZELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:336-931-0432
Mailing Address - Street 1:7607A ALCORN RD
Mailing Address - Street 2:SAME
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9781
Mailing Address - Country:US
Mailing Address - Phone:336-931-0432
Mailing Address - Fax:336-370-9009
Practice Address - Street 1:7607A ALCORN RD
Practice Address - Street 2:SAME
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9781
Practice Address - Country:US
Practice Address - Phone:336-931-0432
Practice Address - Fax:336-370-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604087Medicaid