# GREENE HAVEN FAMILY CARE HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gullatte Enterprises
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124234166
- **Authorized official:** MRS. LATARSHA ROSEBORO GULLATTE (ADMINISTRATOR)
- **Authorized official phone:** (704) 487-0063

## Contact information

- **Practice address:** 1833 STONY POINT RD, SHELBY, NC 28150-9601
- **Practice address phone:** (704) 487-0063
- **Practice address fax:** (704) 482-8001
- **Mailing address:** 1833 STONY POINT RD, SHELBY, NC 28150-9601
- **Mailing address phone:** (704) 487-0063
- **Mailing address fax:** (704) 482-8001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | FCL-023-009 | NC | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 09/24/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7804719 | — | NC |