Provider Demographics
NPI:1851648935
Name:GREENHART
Entity Type:Organization
Organization Name:GREENHART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-780-6492
Mailing Address - Street 1:440 PRIVATE ROAD 5610
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-5332
Mailing Address - Country:US
Mailing Address - Phone:903-780-6492
Mailing Address - Fax:903-962-4020
Practice Address - Street 1:440 PRIVATE ROAD 5610
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-5332
Practice Address - Country:US
Practice Address - Phone:903-780-6492
Practice Address - Fax:903-962-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities