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General NPI Number Information
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NPI Number | 1619538824
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Entity Type | Organization
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Legal Business Name | GREEN FAMILY TREE, INC.
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2120 FOOTHILL BLVD STE 115
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City | LA VERNE
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State | CA
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Zip | 91750-2949
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Country | US
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Telephone | 888-647-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 FOOTHILL BLVD STE 115
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City | LA VERNE
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State | CA
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Zip | 91750-2949
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Country | US
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Telephone | 888-647-3622
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALEXANDRIA L GREEN
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Credential | SLP
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Telephone | 888-647-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities 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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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