Provider Demographics
NPI:1912787151
Name:ENVISION ONE CULTIVATION & ENRICHMENT CENTER, CORP
Entity Type:Organization
Organization Name:ENVISION ONE CULTIVATION & ENRICHMENT CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHAM-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-519-6895
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:VA
Mailing Address - Zip Code:23897-0006
Mailing Address - Country:US
Mailing Address - Phone:804-519-6895
Mailing Address - Fax:
Practice Address - Street 1:9436 MAYES ST STE 8
Practice Address - Street 2:
Practice Address - City:JARRATT
Practice Address - State:VA
Practice Address - Zip Code:23867-9108
Practice Address - Country:US
Practice Address - Phone:804-519-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder