Provider Demographics
NPI:1639170319
Name:GREENVILLE PARTNERSHIP LTD
Entity Type:Organization
Organization Name:GREENVILLE PARTNERSHIP LTD
Other - Org Name:PINE LAKE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-2522
Mailing Address - Street 1:2851 REMINGTON GREEN CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1505
Mailing Address - Country:US
Mailing Address - Phone:850-386-2522
Mailing Address - Fax:850-386-1552
Practice Address - Street 1:HIGHWAY 90 EAST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331
Practice Address - Country:US
Practice Address - Phone:850-948-4601
Practice Address - Fax:850-948-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1258950001Medicare NSC
FL105824Medicare ID - Type Unspecified