Provider Demographics
NPI:1154751709
Name:GREENBRIAR APARTMENTS, LLC
Entity type:Organization
Organization Name:GREENBRIAR APARTMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHALE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-234-5739
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0185
Mailing Address - Country:US
Mailing Address - Phone:562-234-5739
Mailing Address - Fax:818-748-6269
Practice Address - Street 1:1350 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1795
Practice Address - Country:US
Practice Address - Phone:608-356-9213
Practice Address - Fax:608-356-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013806310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0013806OtherD.H.S.