Provider Demographics
NPI:1023294899
Name:GREENBRIAR RETIREMENT
Entity type:Organization
Organization Name:GREENBRIAR RETIREMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGSIYAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-433-6424
Mailing Address - Street 1:3615 MCNEIL RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6818
Mailing Address - Country:US
Mailing Address - Phone:407-433-6424
Mailing Address - Fax:407-521-2901
Practice Address - Street 1:3615 MCNEIL RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6818
Practice Address - Country:US
Practice Address - Phone:407-433-6424
Practice Address - Fax:407-521-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9202310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689265500Medicaid