Provider Demographics
NPI:1376197079
Name:GREEN MOUNTAIN HEALTHCARE LLC
Entity Type:Organization
Organization Name:GREEN MOUNTAIN HEALTHCARE LLC
Other - Org Name:THE HEALTHCARE CENTER AT PATRIOT HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:5000 FAWN MDWS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1539
Mailing Address - Country:US
Mailing Address - Phone:210-696-6005
Mailing Address - Fax:210-641-7881
Practice Address - Street 1:5000 FAWN MDWS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-696-6005
Practice Address - Fax:210-641-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility