MEDICARE: GREENHURST SNF OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1063229805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENHURST SNF OPERATIONS LLC

Provider Business Mailing Address
First Line	:	2230 S MACARTHUR DR STE 9
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3059
Country	:	US
Telephone Number	:	318-443-8167
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 SKYLER DR
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9337
Country	:	US
Telephone Number	:	479-965-7373
Fax Number	:	479-965-7372

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN PONTHIE
Credential	:
Telephone Number	:	318-216-3316

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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