# CCJ ADULT CARE III LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Greene Haven Family Care Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215604822
- **Authorized official:** BERNICE R HOSCH (ADMINISTRATOR/OPERATOR)
- **Authorized official phone:** (980) 295-3020

## Contact information

- **Practice address:** 1833 STONEY POINT RD, SHELBY, NC 28150-9601
- **Practice address phone:** (980) 295-3020
- **Mailing address:** PO BOX 74, BESSEMER CITY, NC 28016-0074
- **Mailing address phone:** (980) 295-3020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/23/2021
- **Last updated:** 09/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | FCL-023-055 | FAMILY CARE HOME | NC |