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General NPI Number Information
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NPI Number | 1295080273
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Entity Type | Organization
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Legal Business Name | GREEN ENERG, INC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 4850 S HILL RD
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City | MILFORD
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State | MI
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Zip | 48381-3936
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Country | US
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Telephone | 248-343-0487
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 S HILL RD
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City | MILFORD
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State | MI
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Zip | 48381-3936
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Country | US
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Telephone | 248-343-0487
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Fax |
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Authorized Official
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Title or Position | CO FOUNDER
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Name | MR. JEFFERY GORETSKI
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Credential | EIT
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Telephone | 248-343-0487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-5124
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License Number State | CA
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