# GREENSBORO LIVING CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740465426
- **Authorized official:** KENNETH R HODGES (MANAGER)
- **Authorized official phone:** (828) 738-3053

## Contact information

- **Practice address:** 3004 DEXTER AVE, GREENSBORO, NC 27407-3616
- **Practice address phone:** (336) 292-1349
- **Practice address fax:** (336) 292-1306
- **Mailing address:** 495 ZION HILL RD, MARION, NC 28752-6304
- **Mailing address phone:** (828) 738-3053
- **Mailing address fax:** (828) 738-0350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | HAL041061 | NC | Yes |

## Other

- **Enumeration date:** 12/31/2007
- **Last updated:** 12/31/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | HAL041061 | LICENSE | NC |