Healthcare Provider Details

I. General information

NPI: 1851841126
Provider Name (Legal Business Name): EMERALD GREEN LIMOUSINE SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13902 WELLINGTON LN
GRAND ISLAND FL
32735-9121
US

IV. Provider business mailing address

13902 WELLINGTON LN
GRAND ISLAND FL
32735-9121
US

V. Phone/Fax

Practice location:
  • Phone: 352-978-2935
  • Fax:
Mailing address:
  • Phone: 352-978-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. PORCHA R. GREEN
Title or Position: CEO
Credential:
Phone: 352-978-2935