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General NPI Number Information
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NPI Number | 1063229805
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Entity Type | Organization
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Legal Business Name | GREENHURST SNF OPERATIONS LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 226 SKYLER DR
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City | CHARLESTON
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State | AR
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Zip | 72933-9337
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Country | US
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Telephone | 479-965-7373
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Fax | 479-965-7372
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Provider Business Mailing Address
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Address Line | 2230 S MACARTHUR DR STE 9
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3059
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Country | US
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Telephone | 318-443-8167
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOHN PONTHIE
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Credential |
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Telephone | 318-216-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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