Provider Demographics
NPI:1851375893
Name:ROLLING GREEN VILLAGE
Entity Type:Organization
Organization Name:ROLLING GREEN VILLAGE
Other - Org Name:ROLLING GREEN VILLAGE HEALTH CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-349-4801
Mailing Address - Street 1:1 HOKE SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5308
Mailing Address - Country:US
Mailing Address - Phone:864-987-9800
Mailing Address - Fax:864-297-0241
Practice Address - Street 1:1 HOKE SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5308
Practice Address - Country:US
Practice Address - Phone:864-987-9800
Practice Address - Fax:864-297-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-456314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425160Medicare Oscar/Certification