Basic Information
| Provider Information | |||||||||
| NPI: | 1265827448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENFIELD OF HAGERSTOWN LLC | ||||||||
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| OtherOrganizationName: | GREENFIELD SENIOR LIVING AT HAGERSTOWN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3612 SEVEN CORNERS CENTER #161 | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220442409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032375606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 CAMEO DR | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217405854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017669202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | PEPONIS | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7039629125 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | MD | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.