Provider Demographics
NPI:1790591006
Name:THE LBC CO. LLC
Entity type:Organization
Organization Name:THE LBC CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-253-8084
Mailing Address - Street 1:3912 BATTLEGROUND AVE STE 112-263
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8575
Mailing Address - Country:US
Mailing Address - Phone:336-708-9294
Mailing Address - Fax:
Practice Address - Street 1:5771 MONCURE PITTSBORO RD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559-9598
Practice Address - Country:US
Practice Address - Phone:336-708-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness