Provider Demographics
NPI:1265827448
Name:GREENFIELD OF HAGERSTOWN LLC
Entity Type:Organization
Organization Name:GREENFIELD OF HAGERSTOWN LLC
Other - Org Name:GREENFIELD SENIOR LIVING AT HAGERSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-962-9125
Mailing Address - Street 1:3612 SEVEN CORNERS CENTER #161
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2409
Mailing Address - Country:US
Mailing Address - Phone:703-237-5606
Mailing Address - Fax:
Practice Address - Street 1:310 CAMEO DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5854
Practice Address - Country:US
Practice Address - Phone:301-766-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility