Provider Demographics
NPI:1841433836
Name:GREENE ACRES HEALTH CENTER, LLC
Entity type:Organization
Organization Name:GREENE ACRES HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-751-3800
Mailing Address - Street 1:588 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6057
Mailing Address - Country:US
Mailing Address - Phone:401-751-3800
Mailing Address - Fax:401-751-6350
Practice Address - Street 1:2052 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:RI
Practice Address - Zip Code:02827-1908
Practice Address - Country:US
Practice Address - Phone:401-397-7504
Practice Address - Fax:401-397-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
415105Medicare Oscar/Certification