Healthcare Provider Details

I. General information

NPI: 1205748290
Provider Name (Legal Business Name): PROMISE HAVEN ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SHERROD WATLINGTON CIR
GREENSBORO NC
27406-9463
US

IV. Provider business mailing address

577 CHESSIE STA
APEX NC
27502-1677
US

V. Phone/Fax

Practice location:
  • Phone: 919-758-9317
  • Fax:
Mailing address:
  • Phone: 919-758-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA JOY BRUNSON-NSUBUGA
Title or Position: CEO
Credential: MBA, LMFT-S, LCAS
Phone: 919-758-9317