=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346849213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREYSTONE BEHAVIORAL HEALTH NURSING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 E ALESSANDRO BLVD STE A438
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92508-5084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-732-8715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 E ALESSANDRO BLVD STE A438
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92508-5084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-732-8715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RAINAT AJOKE SALAAM
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 310-493-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------