Basic Information
| Provider Information | |||||||||
| NPI: | 1760520936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENHURST, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 SKYLER DR | ||||||||
| Address2: | POB 458 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729339337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799657373 | ||||||||
| FaxNumber: | 4799657372 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 SKYLER DR | ||||||||
| Address2: | POB 458 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729339337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799657373 | ||||||||
| FaxNumber: | 4799657372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHAFFER | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4799652233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 109059311 | AR | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 109059311 | 05 | AR | MEDICAID |