Provider Demographics
NPI:1962409797
Name:GREENBRIAR AT THE ALTAMONT, LLC
Entity type:Organization
Organization Name:GREENBRIAR AT THE ALTAMONT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:RENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8460
Mailing Address - Street 1:600 CORPORATE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2934
Mailing Address - Country:US
Mailing Address - Phone:205-783-8472
Mailing Address - Fax:204-783-8441
Practice Address - Street 1:2831 HIGHLAND AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1801
Practice Address - Country:US
Practice Address - Phone:205-323-2724
Practice Address - Fax:205-714-3195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOLAND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10295310400000X
AL10548314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47581308Medicaid
AL47581308Medicaid
AL015446Medicare ID - Type Unspecified