Provider Demographics
NPI:1154560290
Name:ALLEGIANCE SPECIALTY HOSPITAL OF GREENVILLE, LLC
Entity type:Organization
Organization Name:ALLEGIANCE SPECIALTY HOSPITAL OF GREENVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:300 S WASHINGTON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4719
Mailing Address - Country:US
Mailing Address - Phone:662-332-7344
Mailing Address - Fax:662-332-7925
Practice Address - Street 1:300 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-3614
Practice Address - Country:US
Practice Address - Phone:318-226-8202
Practice Address - Fax:318-226-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS252013Medicare Oscar/Certification