Healthcare Provider Details

I. General information

NPI: 1710676622
Provider Name (Legal Business Name): CAREBRIDGE SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 FAIRVIEW ST
GREENSBORO NC
27405-4919
US

IV. Provider business mailing address

2505 FAIRVIEW ST
GREENSBORO NC
27405-4919
US

V. Phone/Fax

Practice location:
  • Phone: 336-907-3030
  • Fax: 336-676-4045
Mailing address:
  • Phone: 336-907-3030
  • Fax: 336-676-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TYISIHA HENRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-405-4946