Basic Information
Provider Information | |||||||||
NPI: | 1891288940 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEXION HEALTH AT GREENWOOD, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CRYSTAL REHABILITATION AND HEALTHCARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6937 WARFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | SYKESVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 217847454 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109357799 | ||||||||
FaxNumber: | 4105524837 | ||||||||
Practice Location | |||||||||
Address1: | 902 SGT JOHN A PITTMAN DR | ||||||||
Address2: |   | ||||||||
City: | GREENWOOD | ||||||||
State: | MS | ||||||||
PostalCode: | 389307343 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6624539173 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2018 | ||||||||
LastUpdateDate: | 06/13/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KIRLEY | ||||||||
AuthorizedOfficialFirstName: | FRANCIS | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 4105524800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NEXION HEALTH, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   |   | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.