1609866383 NPI number — GREENE COUNTY GENERAL HOSPITAL

Table of content: (NPI 1609866383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609866383 NPI number — GREENE COUNTY GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENE COUNTY GENERAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SERENITY SPRING SENIOR LIVING AT JASONVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609866383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1185 N 1000 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47441-5282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-847-2281
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E OHIO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47438-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-665-2226
Provider Business Practice Location Address Fax Number:
812-665-2229
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REETZ
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-847-5212

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100367980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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