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General NPI Number Information
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NPI Number | 1821472358
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Entity Type | Organization
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Legal Business Name | GREEN KLEEN LLC
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 7316 ESSEX DR
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City | YPSILANTI
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State | MI
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Zip | 48197-3176
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Country | US
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Telephone | 734-834-8301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 970138
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City | YPSILANTI
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State | MI
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Zip | 48197-0019
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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 | CEO
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Name | GREGORY TERRELL
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Credential |
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Telephone | 734-834-8301
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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 |
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License Number State |
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