Healthcare Provider Details

I. General information

NPI: 1700097029
Provider Name (Legal Business Name): GREENFIELDS HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E ALBERTONI ST #109
CARSON CA
90746-1539
US

IV. Provider business mailing address

637 E ALBERTONI ST #109
CARSON CA
90746-1539
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-0063
  • Fax: 310-626-9754
Mailing address:
  • Phone: 310-532-0063
  • Fax: 310-626-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ANDREW CHIKE NWEKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-532-0063