Greensboro Living Center, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL041061 Issued in NC

Legal business name

GREENSBORO LIVING CENTER, LLC

Practice address

3004 Dexter Ave
Greensboro, NC 27407-3616

Phone

(336) 292-1349

Fax

(336) 292-1306

NPI assigned

Dec 31, 2007

Organization subpart

No

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

Authorized official

Name

Kenneth R Hodges

Title

Manager

Phone

(828) 738-3053

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1740465426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 ZION HILL RD",
            "city": "MARION",
            "state": "NC",
            "postal_code": "287526304",
            "telephone_number": "828-738-3053",
            "fax_number": "828-738-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 DEXTER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073616",
            "telephone_number": "336-292-1349",
            "fax_number": "336-292-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENSBORO LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "828-738-3053"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL041061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "HAL041061",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Greensboro, NC
• Providers in Greensboro, 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 Dec 31, 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.