Skyland Manor PCH

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

061-01-329-1 Issued in GA

Legal business name

SKYLAND MANOR PCH

Practice address

3505 Skyland Dr
Loganville, GA 30052-8962

Phone

(770) 985-3400

Fax

(770) 985-3425

NPI assigned

Oct 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Hugh Henderson GreenidgeNPI 1598904864

Title

Member/Manager

Phone

(646) 269-9764

Specialties & licenses 1

Addresses

Other names 1

• Greenidge And Associates LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hugh Henderson Greenidge, LPN

  • Licensed Practical Nurse
  • Queens Village, NY
  • NPI 1598904864
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225238400000",
    "number": "1992958474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22546 MURDOCK AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292729",
            "telephone_number": "646-269-9764",
            "fax_number": "718-465-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 SKYLAND DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528962",
            "telephone_number": "770-985-3400",
            "fax_number": "770-985-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLAND MANOR PCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-29",
        "last_updated": "2008-10-29",
        "status": "A",
        "authorized_official_last_name": "GREENIDGE",
        "authorized_official_first_name": "HUGH",
        "authorized_official_middle_name": "HENDERSON",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "646-269-9764",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "061-01-329-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenidge And Associates LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jennifer Marie Sims, MS, OTR/L
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• Lisa Marie Slaughter, R.PH.
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• Anthony Stephone Smith

• Assisted Living Facility in Loganville, GA
• Providers in Loganville, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.