Healthcare Provider Details

I. General information

NPI: 1730142803
Provider Name (Legal Business Name): GREEN VALLEY TERRACE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S WASHINGTON ST
MILLSBORO DE
19966-1236
US

IV. Provider business mailing address

400 RELLA BLVD STE 200
MONTEBELLO NY
10901-4239
US

V. Phone/Fax

Practice location:
  • Phone: 302-934-7300
  • Fax: 302-934-9399
Mailing address:
  • Phone: 732-551-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1100
License Number StateDE

VIII. Authorized Official

Name: FAIGE SHOSHANA
Title or Position: DIRECTOR OF CONTRACTING
Credential:
Phone: 732-551-4803