Healthcare Provider Details

I. General information

NPI: 1205564978
Provider Name (Legal Business Name): GREEN PASTURES THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 MILLER RD STE 5C
SWARTZ CREEK MI
48473-1115
US

IV. Provider business mailing address

9001 MILLER RD STE 5C
SWARTZ CREEK MI
48473-1115
US

V. Phone/Fax

Practice location:
  • Phone: 810-370-0370
  • Fax: 810-603-7665
Mailing address:
  • Phone: 810-370-0370
  • Fax: 810-603-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOSEPH ROSE
Title or Position: CEO
Credential: LCSW
Phone: 810-370-0370