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NPI Code Detail

MEDICARE: GREENACRE HOMES, INC.

MEDICARE: GREENACRE HOMES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1184396301
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREENACRE HOMES, INC.
Provider Business Mailing Address
First Line : 438 EDDIE LN
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-3425
Country : US
Telephone Number : 707-823-8722
Fax Number : 707-823-3730
Provider Business Practice Location Address
First Line : 438 EDDIE LN
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-3425
Country : US
Telephone Number : 707-823-8722
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE DIRECTOR
Name : MR. RICH AGUIRRE
Credential :
Telephone Number : 707-823-8722
Provider Enumeration Date : 10/05/2021
Last Update Date : 10/26/2021

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Directions to “GREENACRE HOMES, INC. ” Practice Location

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