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General NPI Number Information
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NPI Number | 1063376945
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Entity Type | Organization
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Legal Business Name | GREEN RURAL REDEVELOPMENT ORGANIZATION
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 300 W PARKVIEW DR
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City | HENDERSON
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State | NC
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Zip | 27536-5954
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Country | US
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Telephone | 252-226-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W PARKVIEW DR
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City | HENDERSON
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State | NC
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Zip | 27536-5954
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Country | US
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Telephone | 252-226-5355
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Fax |
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Authorized Official
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Title or Position | CHEIF FINANCIAL OFFICER
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Name | JUDITH WILLIAMS MODESTE
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Credential |
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Telephone | 252-432-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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