Provider Demographics
NPI:1861633117
Name:GREENWOOD STATION INC.
Entity Type:Organization
Organization Name:GREENWOOD STATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:CHU
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-807-5236
Mailing Address - Street 1:3005 BONVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5335
Mailing Address - Country:US
Mailing Address - Phone:301-460-2803
Mailing Address - Fax:301-933-2457
Practice Address - Street 1:3005 BONVIEW LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5335
Practice Address - Country:US
Practice Address - Phone:301-460-2803
Practice Address - Fax:301-933-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL0282310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility