Healthcare Provider Details

I. General information

NPI: 1760520936
Provider Name (Legal Business Name): GREENHURST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SKYLER DR POB 458
CHARLESTON AR
72933-9337
US

IV. Provider business mailing address

226 SKYLER DR POB 458
CHARLESTON AR
72933-9337
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-7373
  • Fax: 479-965-7372
Mailing address:
  • Phone: 479-965-7373
  • Fax: 479-965-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number109059311
License Number StateAR

VIII. Authorized Official

Name: MR. FRED H. SCHAFFER
Title or Position: PRESIDENT
Credential: RN
Phone: 479-965-2233