Provider Demographics
NPI:1255654828
Name:GREEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:GREEN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-298-8489
Mailing Address - Street 1:PO BOX 141703
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-1703
Mailing Address - Country:US
Mailing Address - Phone:305-298-8489
Mailing Address - Fax:
Practice Address - Street 1:2645 S DOUGLAS RD
Practice Address - Street 2:SUITE 501
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-298-8489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty