Provider Demographics
NPI:1760511745
Name:GREENE ACRES NURSING HOME ASSOCIATION,INC.
Entity Type:Organization
Organization Name:GREENE ACRES NURSING HOME ASSOCIATION,INC.
Other - Org Name:GREENE ACRES NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-236-8771
Mailing Address - Street 1:2402 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-1963
Mailing Address - Country:US
Mailing Address - Phone:870-236-8771
Mailing Address - Fax:870-239-8948
Practice Address - Street 1:2402 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-1963
Practice Address - Country:US
Practice Address - Phone:870-236-8771
Practice Address - Fax:870-239-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR070066-84-001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045424Medicare PIN
AR045424Medicare Oscar/Certification