Healthcare Provider Details

I. General information

NPI: 1134830664
Provider Name (Legal Business Name): SALENA EBOKPO LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALENA PINCKNEY LLC

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SADDLEHORSE LN
GREENSBORO NC
27405-9804
US

IV. Provider business mailing address

107 SADDLEHORSE LN REEDY FORK RANCH
GREENSBORO NC
27405-9804
US

V. Phone/Fax

Practice location:
  • Phone: 336-332-9600
  • Fax:
Mailing address:
  • Phone: 336-332-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: