Healthcare Provider Details

I. General information

NPI: 1326116492
Provider Name (Legal Business Name): GREEN PARK LEASING CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 GREEN PARK RD
SAINT LOUIS MO
63123-7211
US

IV. Provider business mailing address

4700 ASHWOOD DR SUITE 200
CINCINNATI OH
45241-2465
US

V. Phone/Fax

Practice location:
  • Phone: 314-845-0900
  • Fax: 314-845-0901
Mailing address:
  • Phone: 513-489-7100
  • Fax: 513-530-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031930
License Number StateMO

VIII. Authorized Official

Name: MS. SANDRA K HUBBARD
Title or Position: DIR OF A/R
Credential:
Phone: 513-530-1327