Healthcare Provider Details

I. General information

NPI: 1497138960
Provider Name (Legal Business Name): UNITED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937A MOUNT HOPE CHU RD
MC LEANSVILLE NC
27301-9628
US

IV. Provider business mailing address

PO BOX 36436
GREENSBORO NC
27416-6436
US

V. Phone/Fax

Practice location:
  • Phone: 336-379-7584
  • Fax:
Mailing address:
  • Phone: 336-379-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-1120
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMHL-041-1120
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-041-1120
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-1120
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-041-1120
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberMHL-041-1120
License Number StateNC

VIII. Authorized Official

Name: MR. ANTHONY PATTERSON
Title or Position: DIRECTOR
Credential:
Phone: 336-379-7584