Provider Demographics
NPI:1790182160
Name:CARE GSL RICHMOND OPCO LLC
Entity Type:Organization
Organization Name:CARE GSL RICHMOND OPCO LLC
Other - Org Name:GREENFIELD RESIDENCES AT MONUMENT AVENUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-257-7949
Mailing Address - Street 1:501 N. ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-257-7949
Mailing Address - Fax:804-257-7949
Practice Address - Street 1:6312 SEVEN CORNERS CENTER #161
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-692-9125
Practice Address - Fax:703-237-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF1104427310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility