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NPI Code Detail

MEDICARE: GREEN DOOR, INC

MEDICARE: GREEN DOOR, 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
11041C0700XClinical Social WorkerLC302086DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123345OTHERDCCHARTERED HEALTH PLAN MCO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982740056
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN DOOR, INC
Provider Business Mailing Address
First Line : 1221 TAYLOR ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20011-5617
Country : US
Telephone Number : 202-464-9200
Fax Number :
Provider Business Practice Location Address
First Line : 1221 TAYLOR ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20011-5617
Country : US
Telephone Number : 202-464-9200
Fax Number :
Authorized Official
Title or Position : DEPUTY DIRECTOR
Name : MR. MICHAEL CLANCY
Credential :
Telephone Number : 202-464-9200
Provider Enumeration Date : 01/29/2007
Last Update Date : 08/22/2020

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Directions to “GREEN DOOR, INC ” Practice Location

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