Organization
GREEN BERET HEALTHCARE AGENCY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMMY MACK (DIRECTOR)
(910) 364-5219
Entity
Organization
Contact information
Practice address
1014 HARVEST GROVE CT, HOPE MILLS, NC 28348-9272
(910) 364-5219
(866) 704-9129
Mailing address
1014 HARVEST GROVE CT, HOPE MILLS, NC 28348-9272
(910) 364-5219
(866) 704-9129
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6602223
—
NC
Enumeration date
04/09/2019
Last updated
04/09/2019
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