Provider Demographics
NPI:1609866383
Name:GREENE COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GREENE COUNTY GENERAL HOSPITAL
Other - Org Name:SERENITY SPRING SENIOR LIVING AT SHAKAMAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-847-5212
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-2281
Mailing Address - Fax:
Practice Address - Street 1:800 E OHIO ST
Practice Address - Street 2:
Practice Address - City:JASONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47438-1607
Practice Address - Country:US
Practice Address - Phone:812-665-2226
Practice Address - Fax:812-665-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100367980AMedicaid
IN200367940AOtherHARMONY HEALTH PLAN
IN000000229768OtherBLUE CROSS BLUE SHIELD
SD155303Medicare Oscar/Certification
IN0140910047Medicare NSC