Provider Demographics
NPI:1609086040
Name:GREENLEAF ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:GREENLEAF ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CHAMALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-692-1230
Mailing Address - Street 1:PO BOX 8594
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-8594
Mailing Address - Country:US
Mailing Address - Phone:605-692-1230
Mailing Address - Fax:605-692-1241
Practice Address - Street 1:308 HILLVIEW RD
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2300
Practice Address - Country:US
Practice Address - Phone:605-698-3500
Practice Address - Fax:605-742-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD41332310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility