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General NPI Number Information
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NPI Number | 1528641214
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Entity Type | Organization
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Legal Business Name | GREEN CROSS FOUNDATION INC.
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 418 E 30TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-3909
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Country | US
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Telephone | 317-641-2026
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Fax |
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Provider Business Mailing Address
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Address Line | 3421 LEE RD
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City | SNELLVILLE
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State | GA
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Zip | 30039-5621
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Country | US
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Telephone | 317-641-2026
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Fax |
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Authorized Official
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Title or Position | COFOUNDER
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Name | DR. CHUKWUUEMEKA CHIDEBELU-EZE
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Credential | DC,MS
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Telephone | 404-671-9564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QR0208X
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Taxonomy Name | Mobile Radiology 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 | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number |
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License Number State |
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Taxonomy #10
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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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