Healthcare Provider Details

I. General information

NPI: 1407771009
Provider Name (Legal Business Name): GREEN CARE CLEANING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 MAYBURY RD
COLUMBUS OH
43232-4659
US

IV. Provider business mailing address

2559 MAYBURY RD
COLUMBUS OH
43232-4659
US

V. Phone/Fax

Practice location:
  • Phone: 678-538-7161
  • Fax:
Mailing address:
  • Phone: 678-538-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: PETTRESS D GORE
Title or Position: OWNER
Credential:
Phone: 678-538-7161