Healthcare Provider Details

I. General information

NPI: 1487315586
Provider Name (Legal Business Name): GREEN APPLE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 E MCDOWELL RD
PHOENIX AZ
85008-4544
US

IV. Provider business mailing address

4717 E MCDOWELL RD
PHOENIX AZ
85008-4544
US

V. Phone/Fax

Practice location:
  • Phone: 252-266-1478
  • Fax:
Mailing address:
  • Phone: 602-282-4830
  • Fax: 602-807-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. TAKESHA SHEARD
Title or Position: OWNER
Credential: MBA
Phone: 602-282-4830