Provider Demographics
NPI:1093959579
Name:GREEN HOUSE CHILD AND FAMILY CENTER, INC.
Entity Type:Organization
Organization Name:GREEN HOUSE CHILD AND FAMILY CENTER, INC.
Other - Org Name:GREEN HOUSE NURSERY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:FAERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-827-7270
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:50A CALL RD.
Mailing Address - City:MILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04461-0729
Mailing Address - Country:US
Mailing Address - Phone:207-827-7270
Mailing Address - Fax:
Practice Address - Street 1:50A CALL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:ME
Practice Address - Zip Code:04461-0729
Practice Address - Country:US
Practice Address - Phone:207-827-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131170000Medicaid