Healthcare Provider Details

I. General information

NPI: 1063229805
Provider Name (Legal Business Name): GREENHURST SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SKYLER DR
CHARLESTON AR
72933-9337
US

IV. Provider business mailing address

2230 S MACARTHUR DR STE 9
ALEXANDRIA LA
71301-3059
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-7373
  • Fax: 479-965-7372
Mailing address:
  • Phone: 318-443-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-216-3316