MEDICARE: GREEN HEALTHCARE LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209003913	IL

General Provider Information

NPI Number	:	1255592234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HEALTHCARE LTD.

Provider Business Mailing Address
First Line	:	3124 S WELLS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3654
Country	:	US
Telephone Number	:	312-925-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4332
Country	:	US
Telephone Number	:	773-921-8000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS SHUWEN HUANG
Credential	:	NP
Telephone Number	:	312-925-7013

Provider Enumeration Date	:	06/22/2008
Last Update Date	:	06/22/2008

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Directions to “GREEN HEALTHCARE LTD. ” Practice Location

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