Provider Demographics
NPI:1093315780
Name:ECO GREEN CORPORATION
Entity Type:Organization
Organization Name:ECO GREEN CORPORATION
Other - Org Name:ECO GREEN CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:OLUGBOLAHAN
Authorized Official - Last Name:JUBRIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-228-1055
Mailing Address - Street 1:3300 BASS LAKE RD STE 320M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3072
Mailing Address - Country:US
Mailing Address - Phone:952-228-1055
Mailing Address - Fax:
Practice Address - Street 1:3274 98TH CIR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1846
Practice Address - Country:US
Practice Address - Phone:612-433-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)