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General NPI Number Information
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NPI Number | 1326116492
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Entity Type | Organization
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Legal Business Name | GREEN PARK LEASING CO., LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 9350 GREEN PARK RD
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City | SAINT LOUIS
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State | MO
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Zip | 63123-7211
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Country | US
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Telephone | 314-845-0900
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Fax | 314-845-0901
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Provider Business Mailing Address
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Address Line | 4700 ASHWOOD DR SUITE 200
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City | CINCINNATI
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State | OH
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Zip | 45241-2465
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Country | US
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Telephone | 513-489-7100
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Fax | 513-530-1359
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Authorized Official
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Title or Position | DIR OF A/R
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Name | MS. SANDRA K HUBBARD
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Credential |
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Telephone | 513-530-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 031930
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License Number State | MO
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