=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932120839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREEN CROSS HOME CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15383 NW 7TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-687-7714
-----------------------------------------------------
Fax | 305-687-4095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15383 NW 7TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-687-7714
-----------------------------------------------------
Fax | 305-687-4095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ARNP
-----------------------------------------------------
Name | MRS. ALINE LA FORTUNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-438-8779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA299999491126
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------