Healthcare Provider Details

I. General information

NPI: 1114874104
Provider Name (Legal Business Name): 1ELEVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

IV. Provider business mailing address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

V. Phone/Fax

Practice location:
  • Phone: 800-784-6845
  • Fax: 781-394-2662
Mailing address:
  • Phone: 800-784-6845
  • Fax: 781-394-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAM DAVID STEELE
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 781-366-3953