Healthcare Provider Details

I. General information

NPI: 1790591006
Provider Name (Legal Business Name): LYB CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 MONCURE PITTSBORO RD
MONCURE NC
27559-9598
US

IV. Provider business mailing address

3912 BATTLEGROUND AVE STE 112-263
GREENSBORO NC
27410-8575
US

V. Phone/Fax

Practice location:
  • Phone: 336-708-9294
  • Fax:
Mailing address:
  • Phone: 336-708-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRYSTAL GISELE JOSEY DAVIS
Title or Position: OWNER
Credential:
Phone: 336-708-9294