Provider Demographics
NPI:1407628829
Name:GREENWOOD REGIONAL REHABILITATION HOSPITAL LLC
Entity Type:Organization
Organization Name:GREENWOOD REGIONAL REHABILITATION HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-2299
Mailing Address - Street 1:1024 N GALLOWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2434
Mailing Address - Country:US
Mailing Address - Phone:972-216-2299
Mailing Address - Fax:
Practice Address - Street 1:1530 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4027
Practice Address - Country:US
Practice Address - Phone:505-856-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty