MEDICARE: TERRY J. GREENE

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	315D00000X	Inpatient Hospice	RN284000	OH
2	310400000X	Assisted Living Facility	RN284000	OH

General Provider Information

NPI Number	:	1801124409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY J. GREENE

Provider Business Mailing Address
First Line	:	5703-05 WHITTIER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3047
Country	:	US
Telephone Number	:	216-391-1192
Fax Number	:	216-391-1192

Provider Business Practice Location Address
First Line	:	5705 WHITTIER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3047
Country	:	US
Telephone Number	:	216-391-1192
Fax Number	:	216-391-1192

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MS. TERRY JUNE GREENE
Credential	:	BSN, RN
Telephone Number	:	216-391-1192

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	11/20/2009

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