MEDICARE: DC GREEN, LLC

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
1	171WH0202X	Home Modifications Contractor	CGC1518368	FL

General Provider Information

NPI Number	:	1245640895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DC GREEN, LLC

Provider Business Mailing Address
First Line	:	2831 EXCHANGE CT STE A
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 EXCHANGE CT STE A
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4046
Country	:	US
Telephone Number	:	877-442-3242
Fax Number	:

Authorized Official
Title or Position	:	PROJECT MANAGER
Name	:	CHARLIE MCENTEE
Credential	:
Telephone Number	:	772-985-6935

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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