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General NPI Number Information
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NPI Number | 1770987380
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Entity Type | Organization
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Legal Business Name | UNITED LIVING, LLC
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 6815 SEATTLE SLEW PL
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City | WHITSETT
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State | NC
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Zip | 27377-6001
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Country | US
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Telephone | 336-255-5896
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 36436
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City | GREENSBORO
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State | NC
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Zip | 27416-6436
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Country | US
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Telephone | 336-379-7584
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Fax | 336-379-7584
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ANTHONY PATTERSON
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Credential |
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Telephone | 336-379-7584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL041718
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License Number State | NC
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