Provider Demographics
NPI:1669070223
Name:ROLLING GREEN VILLAGE
Entity type:Organization
Organization Name:ROLLING GREEN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRWOMEN
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS-MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-987-9800
Mailing Address - Street 1:1 HOKE SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-987-9800
Mailing Address - Fax:864-297-0241
Practice Address - Street 1:1 HOKE SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-987-9800
Practice Address - Fax:864-297-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility