Provider Demographics
NPI:1275514788
Name:GREENSBORO HOSPITAL ASSOC INC
Entity Type:Organization
Organization Name:GREENSBORO HOSPITAL ASSOC INC
Other - Org Name:GREENSBORO NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:COMFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-533-7051
Mailing Address - Street 1:47 MAGGIES POND RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05841-8800
Mailing Address - Country:US
Mailing Address - Phone:802-533-7051
Mailing Address - Fax:802-533-7054
Practice Address - Street 1:47 MAGGIES POND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:VT
Practice Address - Zip Code:05841-8800
Practice Address - Country:US
Practice Address - Phone:802-533-7051
Practice Address - Fax:802-533-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0270000340314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0475043Medicaid
VT475043OtherMEDICARE ID
VT475043OtherMEDICARE ID
VT475043Medicare PIN
VT475043Medicare UPIN