Healthcare Provider Details

I. General information

NPI: 1245640895
Provider Name (Legal Business Name): DC GREEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 EXCHANGE CT STE A
WEST PALM BEACH FL
33409-4046
US

IV. Provider business mailing address

2831 EXCHANGE CT STE A
WEST PALM BEACH FL
33409-4046
US

V. Phone/Fax

Practice location:
  • Phone: 877-442-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberCGC1518368
License Number StateFL

VIII. Authorized Official

Name: CHARLIE MCENTEE
Title or Position: PROJECT MANAGER
Credential:
Phone: 772-985-6935