Provider Demographics
NPI:1740341130
Name:GREENBRIER SCHOOL DISTRICT
Entity type:Organization
Organization Name:GREENBRIER SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DECORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-679-1057
Mailing Address - Street 1:4 SCHOOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9267
Mailing Address - Country:US
Mailing Address - Phone:501-679-4808
Mailing Address - Fax:501-679-1024
Practice Address - Street 1:4 SCHOOL DRIVE
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9267
Practice Address - Country:US
Practice Address - Phone:501-679-4808
Practice Address - Fax:501-679-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122400743Medicaid
AR122399742Medicaid