Healthcare Provider Details

I. General information

NPI: 1922938257
Provider Name (Legal Business Name): LASTING IMPRESSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 BLAZINGWOOD DR
GREENSBORO NC
27406-8265
US

IV. Provider business mailing address

907 BLAZINGWOOD DR
GREENSBORO NC
27406-8265
US

V. Phone/Fax

Practice location:
  • Phone: 336-848-9222
  • Fax: 336-848-9222
Mailing address:
  • Phone: 336-848-9222
  • Fax: 336-848-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE PEGUESE CRUMPTON
Title or Position: OWNER
Credential: QP
Phone: 336-848-9222