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
—
—
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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