Healthcare Provider Details

I. General information

NPI: 1114290608
Provider Name (Legal Business Name): SUCCESSFUL VISIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 ALAMANCE COURT
GREENSBORO NC
27406-3806
US

IV. Provider business mailing address

1030 ALAMANCE COURT
GREENSBORO NC
27406-3806
US

V. Phone/Fax

Practice location:
  • Phone: 336-255-8279
  • Fax: 336-217-8842
Mailing address:
  • Phone: 336-255-8279
  • Fax: 336-217-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LISA ANN MORRISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-255-8279