Healthcare Provider Details

I. General information

NPI: 1801124409
Provider Name (Legal Business Name): TERRY J. GREENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 WHITTIER AVE
CLEVELAND OH
44103-3047
US

IV. Provider business mailing address

5703-05 WHITTIER AVE
CLEVELAND OH
44103-3047
US

V. Phone/Fax

Practice location:
  • Phone: 216-391-1192
  • Fax: 216-391-1192
Mailing address:
  • Phone: 216-391-1192
  • Fax: 216-391-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRN284000
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberRN284000
License Number StateOH

VIII. Authorized Official

Name: MS. TERRY JUNE GREENE
Title or Position: REGISTERED NURSE
Credential: BSN, RN
Phone: 216-391-1192