Provider Demographics
NPI:1235348442
Name:GREENBRIER VILLAGE ADULT DAY SERVICES, LLC
Entity Type:Organization
Organization Name:GREENBRIER VILLAGE ADULT DAY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-0121
Mailing Address - Street 1:1217 E OWEN K GARRIOTT RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6235
Mailing Address - Country:US
Mailing Address - Phone:580-234-5827
Mailing Address - Fax:
Practice Address - Street 1:1217 E OWEN K GARRIOTT RD
Practice Address - Street 2:SUITE 216
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6235
Practice Address - Country:US
Practice Address - Phone:580-234-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC2404-2404261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care