Provider Demographics
NPI:1225809643
Name:GREYSTAR HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:GREYSTAR HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIJA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:956-462-2049
Mailing Address - Street 1:11631 CULEBRA RD UNIT 499
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6999
Mailing Address - Country:US
Mailing Address - Phone:956-462-2049
Mailing Address - Fax:956-462-2035
Practice Address - Street 1:11631 CULEBRA RD UNIT 499
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6999
Practice Address - Country:US
Practice Address - Phone:956-462-2049
Practice Address - Fax:956-462-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility