Provider Demographics
NPI:1235440900
Name:GLORIFIED HEALTH & REHAB OF GREENVILLE, LLC
Entity Type:Organization
Organization Name:GLORIFIED HEALTH & REHAB OF GREENVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:8 N TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-5034
Mailing Address - Country:US
Mailing Address - Phone:864-295-1331
Mailing Address - Fax:864-269-7414
Practice Address - Street 1:8 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-5034
Practice Address - Country:US
Practice Address - Phone:864-295-1331
Practice Address - Fax:864-269-7414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK SOUTH CAROLINA HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1016Medicaid
425102Medicare Oscar/Certification