Provider Demographics
NPI:1861476442
Name:TRILOGY HEALTHCARE OF GREENVILLE, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF GREENVILLE, LLC
Other - Org Name:VILLAGE GREEN HEALTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:1315 KITCHEN AID WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1394
Practice Address - Country:US
Practice Address - Phone:937-548-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY OPCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-06
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2677314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112671Medicaid
OH0060404Medicaid
OH0299725Medicaid
OH365505Medicare Oscar/Certification
OH0060404Medicaid