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General NPI Number Information
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NPI Number | 1205748290
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Entity Type | Organization
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Legal Business Name | PROMISE HAVEN ADULT CARE LLC
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 1401 SHERROD WATLINGTON CIR
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City | GREENSBORO
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State | NC
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Zip | 27406-9463
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Country | US
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Telephone | 919-758-9317
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Fax |
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Provider Business Mailing Address
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Address Line | 577 CHESSIE STA
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City | APEX
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State | NC
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Zip | 27502-1677
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Country | US
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Telephone | 919-758-9317
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. REBECCA JOY BRUNSON-NSUBUGA
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Credential | MBA, LMFT-S, LCAS
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Telephone | 919-758-9317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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