MEDICARE: GREENHURST, 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	313M00000X	Nursing Facility/Intermediate Care Facility	109059311	AR

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	:	1760520936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENHURST, INC.

Provider Business Mailing Address
First Line	:	226 SKYLER DR
Second Line	:	POB 458
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9337
Country	:	US
Telephone Number	:	479-965-7373
Fax Number	:	479-965-7372

Provider Business Practice Location Address
First Line	:	226 SKYLER DR
Second Line	:	POB 458
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9337
Country	:	US
Telephone Number	:	479-965-7373
Fax Number	:	479-965-7372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRED H. SCHAFFER
Credential	:	RN
Telephone Number	:	479-965-2233

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/10/2015

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