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General NPI Number Information
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NPI Number | 1215770979
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Entity Type | Organization
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Legal Business Name | GREENHEAVEN BOARDING HOME LLC
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 2944 ETTA DR
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City | DALLAS
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State | TX
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Zip | 75227-7234
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Country | US
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Telephone | 214-695-2894
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 ASPEN HILL DR
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City | FORNEY
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State | TX
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Zip | 75126-3942
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Country | US
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Telephone | 214-695-2894
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN K MAINA
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Credential | RN
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Telephone | 214-695-2894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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