Provider Demographics
NPI:1376209296
Name:GREENACRE HOMES, INC.
Entity Type:Organization
Organization Name:GREENACRE HOMES, INC.
Other - Org Name:HURLBUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-823-8722
Mailing Address - Street 1:438 EDDIE LN
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3425
Mailing Address - Country:US
Mailing Address - Phone:707-823-8722
Mailing Address - Fax:
Practice Address - Street 1:1534 HURLBUT AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2877
Practice Address - Country:US
Practice Address - Phone:707-823-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENACRE HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-15
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness