Healthcare Provider Details

I. General information

NPI: 1235314261
Provider Name (Legal Business Name): GREEN VALLEY TERRACE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S WASHINGTON ST
MILLSBORO DE
19966-1236
US

IV. Provider business mailing address

2919 AVENUE K
BROOKLYN NY
11210-4053
US

V. Phone/Fax

Practice location:
  • Phone: 302-934-7300
  • Fax:
Mailing address:
  • Phone: 718-692-2200
  • Fax: 718-692-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateDE

VIII. Authorized Official

Name: ZEVI KOHN
Title or Position: CFO
Credential:
Phone: 718-692-2200