Healthcare Provider Details

I. General information

NPI: 1063376945
Provider Name (Legal Business Name): GREEN RURAL REDEVELOPMENT ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

300 W PARKVIEW DR
HENDERSON NC
27536-5954
US

IV. Provider business mailing address

300 W PARKVIEW DR
HENDERSON NC
27536-5954
US

V. Phone/Fax

Practice location:
  • Phone: 252-226-5355
  • Fax:
Mailing address:
  • Phone: 252-226-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JUDITH WILLIAMS MODESTE
Title or Position: CHEIF FINANCIAL OFFICER
Credential:
Phone: 252-432-5585