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General NPI Number Information
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NPI Number | 1457207508
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Entity Type | Organization
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Legal Business Name | GREEN PARK ASSISTED LIVING
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 118 MALLORY AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1147
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Country | US
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Telephone | 929-393-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 118 MALLORY AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1147
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Country | US
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Telephone | 862-305-9241
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Fax |
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Authorized Official
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Title or Position | ADMININSTRATOR
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Name | MS. SUCCESS OSARETIN
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Credential |
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Telephone | 929-393-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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