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General NPI Number Information
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NPI Number | 1114884673
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Entity Type | Organization
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Legal Business Name | GREEN BEAN GROVE LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1108 OSHAUGHNESSY AVE NE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6261
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Country | US
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Telephone | 256-213-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 OSHAUGHNESSY AVE NE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6261
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Country | US
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Telephone | 256-213-1702
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | LESLIE JOHNSON
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Credential | RD
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Telephone | 256-679-4764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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