Healthcare Provider Details

I. General information

NPI: 1760625313
Provider Name (Legal Business Name): THE GREENS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12942 WORNALL RD
KANSAS CITY MO
64145-1253
US

IV. Provider business mailing address

12942 WORNALL RD
KANSAS CITY MO
64145-1253
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-6705
  • Fax:
Mailing address:
  • Phone: 816-942-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036771
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT W REDMAN
Title or Position: OWNER
Credential:
Phone: 816-415-9700