Provider Demographics
NPI:1891268819
Name:GREENWICH BAY AL OPERATOR, LLC
Entity Type:Organization
Organization Name:GREENWICH BAY AL OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KISHA-GAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-427-2669
Mailing Address - Street 1:1416 CLARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:945 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3150
Practice Address - Country:US
Practice Address - Phone:401-885-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A