Provider Demographics
NPI:1003815127
Name:GREENBRIER COUNTY NURSING HOME ASSOCIATION
Entity Type:Organization
Organization Name:GREENBRIER COUNTY NURSING HOME ASSOCIATION
Other - Org Name:GREENBRIER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-3076
Mailing Address - Street 1:RR 2 BOX 159A
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9335
Mailing Address - Country:US
Mailing Address - Phone:304-645-3076
Mailing Address - Fax:304-645-3112
Practice Address - Street 1:RR 2 BOX 159A
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9335
Practice Address - Country:US
Practice Address - Phone:304-645-3076
Practice Address - Fax:304-645-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003729000Medicaid
WV0003729000Medicaid