Healthcare Provider Details

I. General information

NPI: 1225239759
Provider Name (Legal Business Name): GREENBREAK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 BARRY LN
LANCASTER TX
75146-2204
US

IV. Provider business mailing address

4800 OVERTON PLZ STE 440
FORT WORTH TX
76109-4435
US

V. Phone/Fax

Practice location:
  • Phone: 800-299-5161
  • Fax: 817-447-3033
Mailing address:
  • Phone: 800-299-5161
  • Fax: 817-447-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA TODD
Title or Position: OPERATIONS BUSINESS MANAGER
Credential:
Phone: 800-299-5161