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NPI Code Detail

MEDICARE: GREEN VALLEY ENTERPRISES, INC.

MEDICARE: GREEN VALLEY ENTERPRISES, INC.
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
1251B00000XCase Management Agency1387-800WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891965356
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN VALLEY ENTERPRISES, INC.
Provider Business Mailing Address
First Line : 1223 MADISON ST
Second Line :
City : BEAVER DAM
State : WI
Zip : 53916-2629
Country : US
Telephone Number : 920-887-4282
Fax Number : 920-887-4292
Provider Business Practice Location Address
First Line : 1223 MADISON ST
Second Line :
City : BEAVER DAM
State : WI
Zip : 53916-2629
Country : US
Telephone Number : 920-887-4282
Fax Number : 920-887-4292
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. JEANINE KNUDSON
Credential :
Telephone Number : 920-887-4282
Provider Enumeration Date : 03/11/2008
Last Update Date : 03/11/2008

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Directions to “GREEN VALLEY ENTERPRISES, INC. ” Practice Location

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