MEDICARE: GREENESSE, LLC

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1366062820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENESSE, LLC

Provider Business Mailing Address
First Line	:	3303 SANDALWOOD DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2310
Country	:	US
Telephone Number	:	404-751-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 SANDALWOOD DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2310
Country	:	US
Telephone Number	:	404-751-8357
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ONOS NANCY BRISIBI
Credential	:
Telephone Number	:	404-751-8357

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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