Basic Information
| Provider Information | |||||||||
| NPI: | 1619138583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENBRIER SENIOR LIVING COMMUNITY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 GLEED AVE | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140522980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166872772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 S MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | PIPER CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156862277 | ||||||||
| FaxNumber: | 8156862812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7166872772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1874890 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.