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General NPI Number Information
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NPI Number | 1891965356
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Entity Type | Organization
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Legal Business Name | GREEN VALLEY ENTERPRISES, INC.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 1223 MADISON ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2629
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Country | US
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Telephone | 920-887-4282
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Fax | 920-887-4292
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Provider Business Mailing Address
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Address Line | 1223 MADISON ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2629
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Country | US
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Telephone | 920-887-4282
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Fax | 920-887-4292
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JEANINE KNUDSON
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Credential |
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Telephone | 920-887-4282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1387-800
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License Number State | WI
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