Healthcare Provider Details

I. General information

NPI: 1699772327
Provider Name (Legal Business Name): THE GREEN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CENTRAL AVE
WELLSBORO PA
16901-1857
US

IV. Provider business mailing address

37 CENTRAL AVE
WELLSBORO PA
16901-1857
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-3131
  • Fax: 570-724-2367
Mailing address:
  • Phone: 570-724-3131
  • Fax: 570-724-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number072202
License Number StatePA

VIII. Authorized Official

Name: ROGER C. YOST
Title or Position: CFO
Credential:
Phone: 570-321-3175