Provider Demographics
NPI:1134124027
Name:GREEN ACRES HEALTH CARE
Entity Type:Organization
Organization Name:GREEN ACRES HEALTH CARE
Other - Org Name:GREEN ACRES HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN LNHA
Authorized Official - Phone:270-247-6477
Mailing Address - Street 1:402 W FARTHING ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2900
Mailing Address - Country:US
Mailing Address - Phone:270-247-6477
Mailing Address - Fax:270-247-0712
Practice Address - Street 1:402 W FARTHING ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2900
Practice Address - Country:US
Practice Address - Phone:270-247-6477
Practice Address - Fax:270-247-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100144314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501342Medicaid
KY12501342Medicaid