Provider Demographics
NPI:1710348305
Name:MAYBROOK-C WHITECLIFF OPCO LLC
Entity Type:Organization
Organization Name:MAYBROOK-C WHITECLIFF OPCO LLC
Other - Org Name:THE GROVE AT GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-588-8090
Mailing Address - Street 1:110 FREDONIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-7911
Mailing Address - Country:US
Mailing Address - Phone:724-588-8090
Mailing Address - Fax:
Practice Address - Street 1:110 FREDONIA ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-7911
Practice Address - Country:US
Practice Address - Phone:724-588-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility