Provider Demographics
NPI:1063229805
Name:GREENHURST SNF OPERATIONS LLC
Entity type:Organization
Organization Name:GREENHURST SNF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-216-3316
Mailing Address - Street 1:2230 S MACARTHUR DR STE 9
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3059
Mailing Address - Country:US
Mailing Address - Phone:318-443-8167
Mailing Address - Fax:
Practice Address - Street 1:226 SKYLER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9337
Practice Address - Country:US
Practice Address - Phone:479-965-7373
Practice Address - Fax:479-965-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility