Provider Demographics
NPI:1457656332
Name:GREEN MEADOWS HOME HEALTH CARE INC,
Entity Type:Organization
Organization Name:GREEN MEADOWS HOME HEALTH CARE INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-838-1055
Mailing Address - Street 1:1442 IRVINE BLVD, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2804
Mailing Address - Country:US
Mailing Address - Phone:714-838-1055
Mailing Address - Fax:714-838-1300
Practice Address - Street 1:1442 IRVINE BLVD, SUITE 104
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2804
Practice Address - Country:US
Practice Address - Phone:714-838-1055
Practice Address - Fax:714-838-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99057885251E00000X, 251F00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059593Medicare Oscar/Certification