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General NPI Number Information
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NPI Number | 1700313798
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Entity Type | Organization
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Legal Business Name | GREEN HOUSE RESIDENCE CARE AND REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 1010 E 33RD ST
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City | BALTIMORE
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State | MD
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Zip | 21218-3780
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Country | US
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Telephone | 410-554-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 585 PROSPECT ST STE 304
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ISRAEL BIRNBAUM
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Credential |
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Telephone | 718-650-0219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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