MEDICARE: HARRIS ENTERPRISES OF NC INC, D/B/A GREENE HAVEN FAMILY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1922282730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS ENTERPRISES OF NC INC, D/B/A GREENE HAVEN FAMILY CARE

Provider Business Mailing Address
First Line	:	PO BOX 1803
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28151-1803
Country	:	US
Telephone Number	:	704-460-4072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 STONY POINT RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-9601
Country	:	US
Telephone Number	:	704-460-4072
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	GEORGETTE ORMSBY
Credential	:
Telephone Number	:	704-460-4072

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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