Healthcare Provider Details

I. General information

NPI: 1740167550
Provider Name (Legal Business Name): FUTURE VISION REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 S MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27107-1306
US

IV. Provider business mailing address

PO BOX 16552
WINSTON SALEM NC
27115-6552
US

V. Phone/Fax

Practice location:
  • Phone: 336-722-1505
  • Fax: 336-725-8638
Mailing address:
  • Phone: 336-722-1505
  • Fax: 336-725-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LAKIAYA BUTLER
Title or Position: DIRECTOR OF PROGRAM SERIVES
Credential:
Phone: 336-722-1505