Healthcare Provider Details

I. General information

NPI: 1629266432
Provider Name (Legal Business Name): GREENBRIER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 KATES MOUNTAIN ROAD
WHITE SULPHUR SPRINGS WV
24986-2414
US

IV. Provider business mailing address

167 KATES MOUNTAIN ROAD
WHITE SULPHUR SPRINGS WV
24986-2414
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax: 304-536-8010
Mailing address:
  • Phone: 304-536-4870
  • Fax: 304-536-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11804
License Number StateWV

VIII. Authorized Official

Name: DR. RICHARD B KLINE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 304-536-4870