=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669070223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROLLING GREEN VILLAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2020
-----------------------------------------------------
Last Update Date | 10/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOKE SMITH BLVD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-987-9800
-----------------------------------------------------
Fax | 864-297-0241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HOKE SMITH BLVD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-987-9800
-----------------------------------------------------
Fax | 864-297-0241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIRWOMEN
-----------------------------------------------------
Name | MRS. VALERIE BROOKS-MADDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-987-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------