| Envisions Of Life Llc | |
|
5 Centerview Dr. Greensboro NC 27407-3709 | |
| (336) 887-0708 | |
| (336) 887-1085 |
| Full Name | Envisions Of Life Llc |
|---|---|
| Speciality | Case Management |
| Location | 5 Centerview Dr., Greensboro, North Carolina |
| Authorized Official Name and Position | Tomeko Moore (PRESIDENT) |
| Authorized Official Contact | 3368870708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envisions Of Life Llc 5 Centerview Dr Ste 110 Greensboro NC 27407-3724 Ph: (336) 887-0708 | Envisions Of Life Llc 5 Centerview Dr. Greensboro NC 27407-3709 Ph: (336) 887-0708 |
| NPI Number | 1881788818 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 03/25/2015 |
| Medicare PECOS PAC ID | 0749317493 |
|---|---|
| Medicare Enrollment ID | O20100428000794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881788818 | NPI | - | NPPES |
| 8301518 | Medicaid | NC | |
| 8301518A | Medicaid | NC |
| Provider Name | Khosrow Bahrani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215982186 PECOS PAC ID: 0648253914 Enrollment ID: I20040608001261 |
| Provider Name | Surya K Challa |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1730162819 PECOS PAC ID: 6901854314 Enrollment ID: I20050115000103 |
| Provider Name | Tomeko M Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336529957 PECOS PAC ID: 3072640721 Enrollment ID: I20150908002372 |
| Provider Name | Glory S Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891393856 PECOS PAC ID: 7618389511 Enrollment ID: I20201217002776 |
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