Healthcare Provider Details

I. General information

NPI: 1700313798
Provider Name (Legal Business Name): GREEN HOUSE RESIDENCE CARE AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 33RD ST
BALTIMORE MD
21218-3780
US

IV. Provider business mailing address

585 PROSPECT ST STE 304
LAKEWOOD NJ
08701-5073
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-9890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISRAEL BIRNBAUM
Title or Position: OWNER
Credential:
Phone: 718-650-0219