Provider Demographics
NPI:1467090803
Name:GREEN PASTURES STILL WATERS, LLC
Entity Type:Organization
Organization Name:GREEN PASTURES STILL WATERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ZIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:716-435-0020
Mailing Address - Street 1:259 GREENHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5551
Mailing Address - Country:US
Mailing Address - Phone:716-435-0020
Mailing Address - Fax:
Practice Address - Street 1:1413 HERTEL AVE STE 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2831
Practice Address - Country:US
Practice Address - Phone:716-922-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN PASTURES STILL WATERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty