Provider Demographics
NPI:1417066358
Name:GREENVILLE HEALTH CORPORATION
Entity Type:Organization
Organization Name:GREENVILLE HEALTH CORPORATION
Other - Org Name:LIFELINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PAYOR STRATEGIES & ALIGNMENT
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-2286
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6307
Mailing Address - Fax:
Practice Address - Street 1:1009 GROVE RD
Practice Address - Street 2:BUILDING C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4600
Practice Address - Country:US
Practice Address - Phone:864-255-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1178Medicaid