Healthcare Provider Details

I. General information

NPI: 1538164264
Provider Name (Legal Business Name): GREENBRIAR NH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 21ST AVE W
BRADENTON FL
34205-8336
US

IV. Provider business mailing address

210 21ST AVE W
BRADENTON FL
34205-8336
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-3786
  • Fax: 941-747-3926
Mailing address:
  • Phone: 941-747-3786
  • Fax: 941-747-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1182096
License Number StateFL

VIII. Authorized Official

Name: MOSHE SCHEINER
Title or Position: CEO
Credential:
Phone: 813-557-6200