Provider Demographics
NPI:1215557772
Name:GREENVILLE OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:GREENVILLE OUTPATIENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-536-9539
Mailing Address - Street 1:PO BOX 551213
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1213
Mailing Address - Country:US
Mailing Address - Phone:954-536-9539
Mailing Address - Fax:
Practice Address - Street 1:437 NW JACKRABBIT LOOP
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3233
Practice Address - Country:US
Practice Address - Phone:954-536-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)