=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720433071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENER PASTURES CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2016
-----------------------------------------------------
Last Update Date | 04/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2127 ESPEY CT SUITE 204
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-292-2080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2127 ESPEY CT SUITE 204
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | REBA WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-292-2080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R3781
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------