Provider Demographics
NPI:1962247866
Name:CAROLINA VISIONS FAMILY CARE LLC
Entity type:Organization
Organization Name:CAROLINA VISIONS FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZURI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-695-2932
Mailing Address - Street 1:3502 DARDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6750
Mailing Address - Country:US
Mailing Address - Phone:336-695-2932
Mailing Address - Fax:
Practice Address - Street 1:2302 W MEADOWVIEW RD STE 104
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3706
Practice Address - Country:US
Practice Address - Phone:336-355-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-041-1268OtherNC DEPARTMENT OF HEALTH AND HUMAN SERVICES