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General NPI Number Information
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NPI Number | 1619360997
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Entity Type | Organization
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Legal Business Name | GREENE CARE LLC
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 74 FOCH CIRCLE #331
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City | NEMACOLIN
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State | PA
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Zip | 15351-0331
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Country | US
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Telephone | 724-998-5683
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Fax | 724-966-7955
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Provider Business Mailing Address
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Address Line | 74 FOCH CIRCLE #331
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City | NEMACOLIN
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State | PA
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Zip | 15351-0331
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Country | US
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Telephone | 724-998-5683
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Fax | 724-966-7955
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID RAGER
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Credential |
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Telephone | 724-998-4296
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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 | 27403601
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License Number State | PA
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