Provider Demographics
NPI:1356817233
Name:GREEN HAVEN HOME CARE LLC
Entity Type:Organization
Organization Name:GREEN HAVEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:360-719-2709
Mailing Address - Street 1:3007 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2258
Mailing Address - Country:US
Mailing Address - Phone:360-719-2709
Mailing Address - Fax:360-984-6350
Practice Address - Street 1:3007 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2258
Practice Address - Country:US
Practice Address - Phone:360-719-2709
Practice Address - Fax:360-984-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care