Greene Haven Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-023-009 Issued in NC

Legal business name

GREENE HAVEN FAMILY CARE HOME

Practice address

1833 Stony Point Rd
Shelby, NC 28150-9601

Phone

(704) 487-0063

Fax

(704) 482-8001

NPI assigned

May 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Latarsha Roseboro Gullatte

Title

Administrator

Phone

(704) 487-0063

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Gullatte Enterprises Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1124234166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 STONY POINT RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281509601",
            "telephone_number": "704-487-0063",
            "fax_number": "704-482-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 STONY POINT RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281509601",
            "telephone_number": "704-487-0063",
            "fax_number": "704-482-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE HAVEN FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "GULLATTE",
        "authorized_official_first_name": "LATARSHA",
        "authorized_official_middle_name": "ROSEBORO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-487-0063",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-023-009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804719",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gullatte Enterprises",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Gragg
• Casey Grant, PHARMD
• Ma'Lee Gray
• Courtney Ann Green, NP
• Donnielle Lynn Green, DO
• Beth Greene
• Julia Grace Greene
• Chandler Lynn Gregory, DC
• Patricia Wiegand Grinton, MD
• Stephen Folger Grinton, MD

• Adult Care Home Facility in Shelby, NC
• Providers in Shelby, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.