Healthcare Provider Details

I. General information

NPI: 1184260085
Provider Name (Legal Business Name): GRNC OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WHITTIER WAY
GHENT NY
12075-3213
US

IV. Provider business mailing address

20 WOOD CT
TARRYTOWN NY
10591-3108
US

V. Phone/Fax

Practice location:
  • Phone: 585-828-0800
  • Fax:
Mailing address:
  • Phone: 914-631-2600
  • 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: ALEXANDER BARTH
Title or Position: MANAGING MEMBER
Credential:
Phone: 914-597-7625