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General NPI Number Information
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NPI Number | 1760511745
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Entity Type | Organization
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Legal Business Name | GREENE ACRES NURSING HOME ASSOCIATION,INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 2402 COUNTRY CLUB RD
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City | PARAGOULD
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State | AR
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Zip | 72450-1963
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Country | US
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Telephone | 870-236-8771
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Fax | 870-239-8948
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Provider Business Mailing Address
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Address Line | 2402 COUNTRY CLUB RD
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City | PARAGOULD
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State | AR
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Zip | 72450-1963
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Country | US
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Telephone | 870-236-8771
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Fax | 870-239-8948
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARLISA THOMPSON
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Credential |
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Telephone | 870-236-8771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 070066-84-001
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License Number State | AR
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