Provider Demographics
NPI:1851155394
Name:GREENVILLE ASSISTED LIVING
Entity Type:Organization
Organization Name:GREENVILLE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MURRY
Authorized Official - Last Name:REAGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-334-4646
Mailing Address - Street 1:1880 FAIRGROUND ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703
Mailing Address - Country:US
Mailing Address - Phone:662-334-4646
Mailing Address - Fax:662-334-4691
Practice Address - Street 1:1880 FAIRGROUND ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703
Practice Address - Country:US
Practice Address - Phone:662-334-4646
Practice Address - Fax:662-334-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility