=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093570418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREEN SPACE CLEANING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2024
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17279 E 109TH AVE
-----------------------------------------------------
City | COMMERCE CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80022-8972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-596-8739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17279 E 109TH AVE
-----------------------------------------------------
City | COMMERCE CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80022-8972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | CECILIA TERRIQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-596-8739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------