Provider Demographics
NPI:1104538396
Name:ROXBORO ASSISTED LIVING OPCO LLC
Entity type:Organization
Organization Name:ROXBORO ASSISTED LIVING OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-697-9920
Mailing Address - Street 1:3012 AVENUE J FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3838
Mailing Address - Country:US
Mailing Address - Phone:727-697-9920
Mailing Address - Fax:
Practice Address - Street 1:5660 DURHAM RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-7958
Practice Address - Country:US
Practice Address - Phone:336-598-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility