Organization
N & R OF GREENE HAVEN LLC
Active
Other names
Jordan Creek
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C LINCOLN (MEMBER)
(573) 481-9625
Entity
Organization
Contact information
Practice address
910 S WEST AVE, SPRINGFIELD, MO 65802-9999
(417) 865-8741
(417) 865-7601
Mailing address
910 S WEST AVE, SPRINGFIELD, MO 65802-9999
(417) 865-8741
(417) 865-7601
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
034476
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101477107
—
MO
01
—
153818
BLUE CROSS BLUE SHIELD
MO
Enumeration date
03/15/2007
Last updated
07/30/2013
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