MEDICARE: GREENBRIAR PRIME MANAGEMENT, 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	310400000X	Assisted Living Facility	125325	TX

General Provider Information

NPI Number	:	1942447750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIAR PRIME MANAGEMENT, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 2260
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76113-2260
Country	:	US
Telephone Number	:	817-535-3827
Fax Number	:	817-535-1362

Provider Business Practice Location Address
First Line	:	7865 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4204
Country	:	US
Telephone Number	:	817-535-3827
Fax Number	:	817-535-1362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DOUG SWEENEY
Credential	:
Telephone Number	:	817-535-3827

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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