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Organization
GREENE HAVEN FAMILY CARE HOME
Active
Organization
GREENE HAVEN FAMILY CARE HOME
Active
Other names
Gullatte Enterprises
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATARSHA ROSEBORO GULLATTE (ADMINISTRATOR)
(704) 487-0063
Entity
Organization
Contact information
Practice address
1833 STONY POINT RD, SHELBY, NC 28150-9601
(704) 487-0063
(704) 482-8001
Mailing address
1833 STONY POINT RD, SHELBY, NC 28150-9601
(704) 487-0063
(704) 482-8001
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
NULL
311ZA0620X
Adult Care Home Facility
Primary
FCL-023-009
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804719
—
NC
Enumeration date
05/15/2007
Last updated
09/24/2007
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