Organization
HAVENPATH SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROOSEVELT SMITH (OWNER)
(704) 662-5250
Entity
Organization
Contact information
Practice address
4518 W MARKET ST STE A, GREENSBORO, NC 27407-1543
(704) 662-5250
Mailing address
4518 W MARKET ST STE A, GREENSBORO, NC 27407-1543
(704) 662-5250
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
09/22/2025
Last updated
01/20/2026
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