Provider Demographics
NPI:1275968083
Name:GREENE, ROBERT EUGENE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8680
Mailing Address - Country:US
Mailing Address - Phone:870-879-1051
Mailing Address - Fax:870-879-0118
Practice Address - Street 1:6841 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-8680
Practice Address - Country:US
Practice Address - Phone:870-879-1051
Practice Address - Fax:870-879-0118
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility