Provider Demographics
NPI:1053590778
Name:VISIONS OF HOPE COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:VISIONS OF HOPE COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARQUES
Authorized Official - Middle Name:ANTWAIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-802-1577
Mailing Address - Street 1:2405 PAULA ST
Mailing Address - Street 2:3
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1755
Mailing Address - Country:US
Mailing Address - Phone:919-802-1577
Mailing Address - Fax:
Practice Address - Street 1:2405 PAULA ST
Practice Address - Street 2:3
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1755
Practice Address - Country:US
Practice Address - Phone:919-802-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness