MEDICARE: ADRIAN GREEN

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1821603788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN GREEN

Provider Business Mailing Address
First Line	:	4525 CROW CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-4614
Country	:	US
Telephone Number	:	719-640-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 CROW CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-4614
Country	:	US
Telephone Number	:	719-640-7115
Fax Number	:

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

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “ ADRIAN GREEN ” Practice Location

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