Provider Demographics
NPI:1396723060
Name:GREENSVILLE MANOR LLC
Entity type:Organization
Organization Name:GREENSVILLE MANOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-348-2150
Mailing Address - Street 1:214 WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1224
Mailing Address - Country:US
Mailing Address - Phone:434-348-2150
Mailing Address - Fax:434-348-2157
Practice Address - Street 1:214 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1224
Practice Address - Country:US
Practice Address - Phone:434-348-2150
Practice Address - Fax:434-348-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2756314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00491999Medicaid
VA00491999Medicaid
VA6320910001Medicare NSC