Provider Demographics
NPI:1073635751
Name:GREENWELL & GREENWELL, INC.
Entity Type:Organization
Organization Name:GREENWELL & GREENWELL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-699-2776
Mailing Address - Street 1:315 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-8128
Mailing Address - Country:US
Mailing Address - Phone:270-699-2776
Mailing Address - Fax:270-699-2780
Practice Address - Street 1:315 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-8128
Practice Address - Country:US
Practice Address - Phone:270-699-2776
Practice Address - Fax:270-699-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3058225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1649OtherFIRST STEPS PROVIDER