Healthcare Provider Details

I. General information

NPI: 1588455430
Provider Name (Legal Business Name): GREEN VALLEY CONSULTING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CORONADO CENTER DR STE 110
HENDERSON NV
89052-4290
US

IV. Provider business mailing address

233 DESERT ARROYO CT
HENDERSON NV
89012-4856
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-9500
  • Fax:
Mailing address:
  • Phone: 702-778-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN J DEVITO
Title or Position: PRESIDENT
Credential:
Phone: 702-778-9500