Organization
GREENBRIER LTC INC
Active
Organization
GREENBRIER LTC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RILEY S EVANS (PRESIDENT)
(910) 648-6887
Entity
Organization
Contact information
Practice address
703 SOUTH WALNUT ST, FAIRMONT, NC 28340
(910) 628-9021
(910) 628-7441
Mailing address
PO BOX 847, CLARKTON, NC 28433
(910) 648-6887
(910) 648-6888
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL078053
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805461
—
NC
Enumeration date
11/20/2006
Last updated
11/08/2007
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