Provider Demographics
NPI:1760520936
Name:GREENHURST, INC.
Entity Type:Organization
Organization Name:GREENHURST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:479-965-2233
Mailing Address - Street 1:226 SKYLER DR
Mailing Address - Street 2:POB 458
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-9337
Mailing Address - Country:US
Mailing Address - Phone:479-965-7373
Mailing Address - Fax:479-965-7372
Practice Address - Street 1:226 SKYLER DR
Practice Address - Street 2:POB 458
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9337
Practice Address - Country:US
Practice Address - Phone:479-965-7373
Practice Address - Fax:479-965-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR109059311313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109059311Medicaid
AR045447Medicare Oscar/Certification