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General NPI Number Information
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NPI Number | 1356817233
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Entity Type | Organization
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Legal Business Name | GREEN HAVEN HOME CARE LLC
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 3007 NE 141ST ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2258
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Country | US
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Telephone | 360-719-2709
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Fax | 360-984-6350
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Provider Business Mailing Address
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Address Line | 3007 NE 141ST ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2258
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Country | US
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Telephone | 360-719-2709
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Fax | 360-984-6350
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Authorized Official
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Title or Position | PROVIDER
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Name | VERONICA ALEXANDRA ESCOBAR
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Credential | CNA
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Telephone | 360-719-2709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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