Provider Demographics
NPI:1215552500
Name:GREEN ISLAND PEST CONTROL. LLC
Entity Type:Organization
Organization Name:GREEN ISLAND PEST CONTROL. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CERTIFIED TECH
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-851-7160
Mailing Address - Street 1:2303 WOODLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8926
Mailing Address - Country:US
Mailing Address - Phone:407-851-7160
Mailing Address - Fax:407-479-3567
Practice Address - Street 1:2303 WOODLEAF CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8926
Practice Address - Country:US
Practice Address - Phone:407-851-7160
Practice Address - Fax:407-479-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL671714401Medicaid