MEDICARE: KAREN GREEN

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1942819446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GREEN

Provider Business Mailing Address
First Line	:	104 WHARTON LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7365
Country	:	US
Telephone Number	:	803-465-0866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 W BELTLINE BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1503
Country	:	US
Telephone Number	:	803-465-0866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	07/30/2020

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Directions to “ KAREN GREEN ” Practice Location

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