Provider Demographics
NPI:1245217678
Name:GREENE COUNTY
Entity Type:Organization
Organization Name:GREENE COUNTY
Other - Org Name:GREENEWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERCIVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-562-7550
Mailing Address - Street 1:711 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2607
Mailing Address - Country:US
Mailing Address - Phone:937-562-7550
Mailing Address - Fax:937-562-7593
Practice Address - Street 1:711 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2607
Practice Address - Country:US
Practice Address - Phone:937-562-7550
Practice Address - Fax:937-562-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342025Medicaid
OH0342025Medicaid