CCJ Adult Care III LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

CCJ ADULT CARE III LLC

Doing business as

Greene Haven Family Care Home

Practice address

1833 Stoney Point Rd
Shelby, NC 28150-9601

Phone

(980) 295-3020

NPI assigned

Aug 23, 2021

Last updated

Sep 15, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bernice R Hosch

Title

Administrator/Operator

Phone

(980) 295-3020

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Greene Haven Family Care Home Doing business as

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1215604822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74",
            "city": "BESSEMER CITY",
            "state": "NC",
            "postal_code": "280160074",
            "telephone_number": "980-295-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 STONEY POINT RD",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281509601",
            "telephone_number": "980-295-3020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W Main Ave Apt 302",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280524172",
            "country_code": "US",
            "telephone_number": "980-295-3020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CCJ ADULT CARE III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "HOSCH",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR/OPERATOR",
        "authorized_official_telephone_number": "980-295-3020"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY CARE HOME",
            "identifier": "FCL-023-055",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greene Haven Family Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Casey
• William Joseph Casp, M.D.
• Danielle Howell Cates, NP
• Cathrines House
• Calvin Leslie Caunt, MD
• Center for Assessment and Treatment Services, Inc.
• Challenges, LLC
• Steven A Chamberlain, MD
• Kelsey L Champney, DPT
• Ryan Christopher Chaney, PA

• 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 15, 2021; 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.