Provider Demographics
NPI:1154772762
Name:GREENLINE HEALTH SERVICES, INC
Entity type:Organization
Organization Name:GREENLINE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-463-4666
Mailing Address - Street 1:7360 HOBGOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2684
Mailing Address - Country:US
Mailing Address - Phone:678-885-9765
Mailing Address - Fax:678-885-9764
Practice Address - Street 1:1572 HIGHWAY 85 N
Practice Address - Street 2:SUITE 338
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:678-885-9765
Practice Address - Fax:678-885-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health