MEDICARE: GREENBRIAR PLACE 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1275328585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIAR PLACE LLC

Provider Business Mailing Address
First Line	:	115 DIGGS DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1757
Country	:	US
Telephone Number	:	757-775-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 DIGGS DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1757
Country	:	US
Telephone Number	:	757-775-0113
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ ADMINISTRATOR
Name	:	MS. JENNINE ROCHELLE BOOTH
Credential	:
Telephone Number	:	757-775-0113

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	02/09/2026

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