Provider Demographics
NPI:1326805383
Name:ALSTON GREEN ASSISTED LIVING
Entity Type:Organization
Organization Name:ALSTON GREEN ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-468-4463
Mailing Address - Street 1:1110 FLORENCE HWY
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-7887
Mailing Address - Country:US
Mailing Address - Phone:803-262-2625
Mailing Address - Fax:803-262-2706
Practice Address - Street 1:1110 FLORENCE HWY
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-7887
Practice Address - Country:US
Practice Address - Phone:803-262-2625
Practice Address - Fax:803-262-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility