Healthcare Provider Details

I. General information

NPI: 1295909158
Provider Name (Legal Business Name): GREENPARK CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SAINT EDWARDS ST
BROOKLYN NY
11201-3904
US

IV. Provider business mailing address

140 SAINT EDWARDS ST
BROOKLYN NY
11201-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-855-6789
  • Fax:
Mailing address:
  • Phone: 718-855-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number1075730001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1075730001
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS QUINN
Title or Position: CONTROLLER
Credential:
Phone: 718-858-6400