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General NPI Number Information
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NPI Number | 1295065472
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Entity Type | Organization
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Legal Business Name | MARK S. GREER
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 3305 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2690
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Country | US
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Telephone | 936-559-9422
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2690
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Country | US
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Telephone | 936-559-9422
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MARK GREER
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Credential |
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Telephone | 936-559-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 3261
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 3260
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License Number State | TX
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