MEDICARE: MRS. CARMEN THERESA GREEN R.N.,B.S.N.,M.B.A.

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1326105008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN THERESA GREEN R.N.,B.S.N.,M.B.A.

Provider Business Mailing Address
First Line	:	17300 SATURN LN
Second Line	:	STE. 112
City	:	HOUSTON
State	:	TX
Zip	:	77058-2261
Country	:	US
Telephone Number	:	281-204-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	17300 SATURN LN
Second Line	:	STE. 112
City	:	HOUSTON
State	:	TX
Zip	:	77058-2261
Country	:	US
Telephone Number	:	281-204-8944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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