MEDICARE: GREEN GRASS RESIDENTIAL CARE HOME

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1851603534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN GRASS RESIDENTIAL CARE HOME

Provider Business Mailing Address
First Line	:	PO BOX 124
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77383-0124
Country	:	US
Telephone Number	:	901-210-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 MARBLE FALLS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-6243
Country	:	US
Telephone Number	:	901-210-3976
Fax Number	:	281-580-1260

Authorized Official
Title or Position	:	OPERATION MANAGER
Name	:	STEVEN L GREEN
Credential	:
Telephone Number	:	901-210-3976

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	07/09/2010

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Directions to “GREEN GRASS RESIDENTIAL CARE HOME ” Practice Location

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