MEDICARE: GREENWOODS, INC.

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	HAL-041-002	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720269087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOODS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 29108
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27429-9108
Country	:	US
Telephone Number	:	336-686-3553
Fax Number	:	336-643-9776

Provider Business Practice Location Address
First Line	:	4501 OLD BATTLEGROUND RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9352
Country	:	US
Telephone Number	:	336-282-2253
Fax Number	:	336-282-1308

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. AVERY BRADLEY GREEN
Credential	:
Telephone Number	:	336-686-3553

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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Directions to “GREENWOODS, INC. ” Practice Location

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