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General NPI Number Information
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NPI Number | 1982158374
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Entity Type | Organization
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Legal Business Name | GREENE WELLNESS AND REHAB CENTER LLC.
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 708 BROADWAY
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City | REVERE
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State | MA
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Zip | 02151-2334
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Country | US
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Telephone | 781-284-4001
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Fax | 781-284-4116
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Provider Business Mailing Address
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Address Line | 708 BROADWAY
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City | REVERE
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State | MA
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Zip | 02151-2334
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Country | US
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Telephone | 781-284-4001
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Fax | 781-284-4116
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RICHIE HERNANDEZ
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Credential |
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Telephone | 781-284-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 692
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License Number State | MA
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