Provider Demographics
NPI:1275974966
Name:GREEN ACRES FAMILY CARE HOME
Entity Type:Organization
Organization Name:GREEN ACRES FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-337-1311
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382-1535
Mailing Address - Country:US
Mailing Address - Phone:910-337-1311
Mailing Address - Fax:
Practice Address - Street 1:8465 PINEY WOODS RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:NC
Practice Address - Zip Code:28478-8833
Practice Address - Country:US
Practice Address - Phone:910-337-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility