MEDICARE: GREEN HILL INC

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	310400000X	Assisted Living Facility	30C001	NJ
2	314000000X	Skilled Nursing Facility	030707	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528061868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HILL INC

Provider Business Mailing Address
First Line	:	103 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2905
Country	:	US
Telephone Number	:	973-731-2300
Fax Number	:	973-325-6009

Provider Business Practice Location Address
First Line	:	103 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2905
Country	:	US
Telephone Number	:	973-731-2300
Fax Number	:	973-325-6009

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR - PRESIDENT
Name	:	MS. TONI LYNN DAVIS
Credential	:	L.N.H.A., MHA.
Telephone Number	:	973-731-2300

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/18/2007

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Directions to “GREEN HILL INC ” Practice Location

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