Provider Demographics
NPI:1487654786
Name:GREENBRIER NURSING HOME NUMBER TWO, INC
Entity Type:Organization
Organization Name:GREENBRIER NURSING HOME NUMBER TWO, INC
Other - Org Name:GREENBRIER NH #2, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-0121
Mailing Address - Street 1:1119 E GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6151
Mailing Address - Country:US
Mailing Address - Phone:580-223-0121
Mailing Address - Fax:580-233-3755
Practice Address - Street 1:1119 E GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6151
Practice Address - Country:US
Practice Address - Phone:580-223-0121
Practice Address - Fax:580-233-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH2404-2404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100775230AMedicaid
OK100775230AMedicaid