Healthcare Provider Details

I. General information

NPI: 1124936190
Provider Name (Legal Business Name): GREEN PATHWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W CHEYENNE AVE STE 100
NORTH LAS VEGAS NV
89032-8252
US

IV. Provider business mailing address

3550 W CHEYENNE AVE STE 100
NORTH LAS VEGAS NV
89032-8252
US

V. Phone/Fax

Practice location:
  • Phone: 661-349-3799
  • Fax:
Mailing address:
  • Phone: 661-349-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ANNTANISHA GREEN
Title or Position: OWNER
Credential:
Phone: 661-349-3799