Healthcare Provider Details

I. General information

NPI: 1407776057
Provider Name (Legal Business Name): LAKIESHA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E PETAIN ST
PRICHARD AL
36610-1725
US

IV. Provider business mailing address

6240 RESTER RD LOT H
THEODORE AL
36582-3920
US

V. Phone/Fax

Practice location:
  • Phone: 251-293-9160
  • Fax:
Mailing address:
  • Phone: 251-207-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: