Provider Demographics
NPI:1659991784
Name:CARE ONE ASSISTED LIVING OF GREENVILLE LLC
Entity Type:Organization
Organization Name:CARE ONE ASSISTED LIVING OF GREENVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GANIYU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-389-5144
Mailing Address - Street 1:2060 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9160
Mailing Address - Country:US
Mailing Address - Phone:252-752-3402
Mailing Address - Fax:252-754-2367
Practice Address - Street 1:2060 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9160
Practice Address - Country:US
Practice Address - Phone:252-752-3402
Practice Address - Fax:252-754-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility