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NPI Code Detail

MEDICARE: GREEN DOOR, INC.

MEDICARE: GREEN DOOR, 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
1101YP2500XProfessional CounselorPRC13817DC

General Provider Information

NPI Number : 1891841391
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN DOOR, INC.
Provider Business Mailing Address
First Line : 1221 TAYLOR ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20011-5617
Country : US
Telephone Number : 202-464-9200
Fax Number : 202-464-5730
Provider Business Practice Location Address
First Line : 1221 TAYLOR ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20011-5617
Country : US
Telephone Number : 202-464-9200
Fax Number : 202-464-5730
Authorized Official
Title or Position : DEPUTY DIRECTOR
Name : MR. MICHAEL CLANCY
Credential :
Telephone Number : 202-464-9200
Provider Enumeration Date : 01/26/2007
Last Update Date : 08/22/2020

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