=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689272023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENBRIAR OPERATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2020
-----------------------------------------------------
Last Update Date | 10/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 HARRIS RD
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-537-8689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 HARRIS RD
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03062-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-537-8689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNOR
-----------------------------------------------------
Name | ARIEL ERLICHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-537-8689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------