Provider Demographics
NPI:1205852712
Name:GREENE COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GREENE COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-847-2281
Mailing Address - Street 1:618 W GLENBURN RD
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5709
Mailing Address - Country:US
Mailing Address - Phone:812-847-2221
Mailing Address - Fax:
Practice Address - Street 1:618 W GLENBURN RD
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5709
Practice Address - Country:US
Practice Address - Phone:812-847-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000230314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100275000AMedicaid
IN000230OtherSTATE LICENSE NUMBER
IN200233900AMedicaid
IN200106730AMedicaid
IN155524Medicare Oscar/Certification