Healthcare Provider Details

I. General information

NPI: 1508505660
Provider Name (Legal Business Name): GREENS AT SPRUCE PINES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 LAUREL CREEK CT
SPRUCE PINE NC
28777-3134
US

IV. Provider business mailing address

15 AMERICA AVE UNIT 304
LAKEWOOD NJ
08701-4582
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-7312
  • Fax: 828-765-7295
Mailing address:
  • Phone:
  • 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: JACOB STERN
Title or Position: CEO
Credential:
Phone: 513-830-5342