{
"Npi": {
"NPI": "1386195840",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ENVISIONS OF LIFE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5 CENTERVIEW DR STE 110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENSBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27407-3709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-887-0708",
"MailingAddressFaxNumber": "336-887-1085",
"FirstLinePracticeLocationAddress": "449 W MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JONESVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28642-2130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-887-0708",
"PracticeLocationAddressFaxNumber": "336-887-1085",
"EnumerationDate": "10/20/2016",
"LastUpdateDate": "09/01/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOORE",
"AuthorizedOfficialFirstName": "TOMEKO",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCAS, LCSWA",
"AuthorizedOfficialTelephoneNumber": "336-887-0708",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320800000X",
"TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
"LicenseNumber": "099-029",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}