Provider Demographics
NPI:1164758330
Name:GREENE COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GREENE COUNTY GENERAL HOSPITAL
Other - Org Name:SERENITY SPRING SENIOR LIVING AT NORTHWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-847-5212
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2515 NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47547-1047
Practice Address - Country:US
Practice Address - Phone:812-482-1722
Practice Address - Fax:812-634-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200951370AMedicaid