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Organization
CCJ ADULT CARE III LLC
Active
Organization
CCJ ADULT CARE III LLC
Active
Other names
Greene Haven Family Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
BERNICE R HOSCH (ADMINISTRATOR/OPERATOR)
(980) 295-3020
Entity
Organization
Contact information
Practice address
1833 STONEY POINT RD, SHELBY, NC 28150-9601
(980) 295-3020
Mailing address
PO BOX 74, BESSEMER CITY, NC 28016-0074
(980) 295-3020
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FCL-023-055
FAMILY CARE HOME
NC
Enumeration date
08/23/2021
Last updated
09/15/2021
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