Provider Demographics
NPI:1285610352
Name:GREENE OAKS
Entity type:Organization
Organization Name:GREENE OAKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:EYRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-352-2800
Mailing Address - Street 1:164 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1647
Mailing Address - Country:US
Mailing Address - Phone:937-352-2800
Mailing Address - Fax:937-352-2841
Practice Address - Street 1:164 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1647
Practice Address - Country:US
Practice Address - Phone:937-352-2800
Practice Address - Fax:937-352-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4589310400000X
OH3392314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0524552Medicaid
OH0663620001Medicare NSC
OH0524552Medicaid