Basic Information
| Provider Information | |||||||||
| NPI: | 1750538757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENLUND ENTERPRISES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 GALLOWAY ST | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547033467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158318966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13452 NORTHLAND DR | ||||||||
| Address2: | |||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493079446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317965858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | FRANCHISE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7158318966 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | Y | Suppliers | Hearing Aid Equipment |
No ID Information.