Provider Demographics
NPI:1225430622
Name:GREENHORN HEALTH SERVICES PCT
Entity Type:Organization
Organization Name:GREENHORN HEALTH SERVICES PCT
Other - Org Name:NEXUS FIDUCIARY FOUNDATION MASTER BUILDERS PCT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-240-3128
Mailing Address - Street 1:PO BOX 19962
Mailing Address - Street 2:6230 WACO MISH ROAD
Mailing Address - City:COLORADO CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81019-0962
Mailing Address - Country:US
Mailing Address - Phone:719-240-3128
Mailing Address - Fax:719-676-2351
Practice Address - Street 1:6230 WACO MISH ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019
Practice Address - Country:US
Practice Address - Phone:719-240-3128
Practice Address - Fax:719-676-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001045251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health