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General NPI Number Information
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NPI Number | 1801960083
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Entity Type | Organization
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Legal Business Name | GREENBRIER LTC INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 703 SOUTH WALNUT ST
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City | FAIRMONT
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State | NC
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Zip | 28340
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Country | US
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Telephone | 910-628-9021
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Fax | 910-628-7441
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Provider Business Mailing Address
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Address Line | PO BOX 847
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City | CLARKTON
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State | NC
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Zip | 28433
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Country | US
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Telephone | 910-648-6887
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Fax | 910-648-6888
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RILEY S EVANS
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Credential |
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Telephone | 910-648-6887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL078053
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License Number State | NC
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