Healthcare Provider Details

I. General information

NPI: 1043450943
Provider Name (Legal Business Name): GREENS NURSING AND ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BRAINARD RD
LYNDHURST OH
44124-3096
US

IV. Provider business mailing address

1575 BRAINARD RD
LYNDHURST OH
44124-3096
US

V. Phone/Fax

Practice location:
  • Phone: 440-646-0000
  • Fax: 440-646-0100
Mailing address:
  • Phone: 440-646-0000
  • Fax: 440-646-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOXY LICENSE PENDING
License Number StateOH

VIII. Authorized Official

Name: MR. ARTHUR L. ROTHGERBER
Title or Position: SR. VICE PRESIDENT OF REIMBURSEMENT
Credential:
Phone: 502-596-7300