Healthcare Provider Details

I. General information

NPI: 1255245064
Provider Name (Legal Business Name): REBOS COLIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S EASTERN ST
GREENVILLE NC
27858-2136
US

IV. Provider business mailing address

1530 EVANS ST STE 206
GREENVILLE NC
27834-5303
US

V. Phone/Fax

Practice location:
  • Phone: 252-818-4450
  • Fax:
Mailing address:
  • Phone: 252-818-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANITA MOORE
Title or Position: OWNER
Credential:
Phone: 252-818-4450