Healthcare Provider Details

I. General information

NPI: 1982013496
Provider Name (Legal Business Name): GREENVILLE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LILA DOYLE DR
SENECA SC
29672-9495
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-7678
  • Fax:
Mailing address:
  • Phone: 864-797-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-0297
License Number StateSC

VIII. Authorized Official

Name: MICHAEL C. RIORDAN
Title or Position: PRESIDENT / CEO
Credential:
Phone: 864-797-7808