Provider Demographics
NPI:1760256531
Name:GREENBRIER CHRISTIAN ACADEMY LLC
Entity Type:Organization
Organization Name:GREENBRIER CHRISTIAN ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEENE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:501-581-0203
Mailing Address - Street 1:221 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9233
Mailing Address - Country:US
Mailing Address - Phone:501-581-0203
Mailing Address - Fax:
Practice Address - Street 1:19 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9263
Practice Address - Country:US
Practice Address - Phone:501-581-0203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty