MEDICARE: GREENBRIAR NH, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	314000000X	Skilled Nursing Facility	SNF1182096	FL

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

General Provider Information

NPI Number	:	1538164264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIAR NH, LLC

Provider Business Mailing Address
First Line	:	210 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8336
Country	:	US
Telephone Number	:	941-747-3786
Fax Number	:	941-747-3926

Provider Business Practice Location Address
First Line	:	210 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8336
Country	:	US
Telephone Number	:	941-747-3786
Fax Number	:	941-747-3926

Authorized Official
Title or Position	:	CEO
Name	:	MOSHE SCHEINER
Credential	:
Telephone Number	:	813-557-6200

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	06/27/2021

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Directions to “GREENBRIAR NH, LLC ” Practice Location

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