Provider Demographics
NPI:1043884596
Name:CENTER FOR AGING AND REHABILITATION OF GREENVILLE INC
Entity Type:Organization
Organization Name:CENTER FOR AGING AND REHABILITATION OF GREENVILLE INC
Other - Org Name:GREENVILLE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-4597
Mailing Address - Street 1:3550 POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5917
Mailing Address - Country:US
Mailing Address - Phone:954-367-4597
Mailing Address - Fax:
Practice Address - Street 1:13455 W US 90
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-4318
Practice Address - Country:US
Practice Address - Phone:954-367-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid