Provider Demographics
NPI:1487190120
Name:SUPRINA GREEN
Entity Type:Organization
Organization Name:SUPRINA GREEN
Other - Org Name:ALACI CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUPRINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-670-0089
Mailing Address - Street 1:5439 WEBER PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4271
Mailing Address - Country:US
Mailing Address - Phone:863-670-0089
Mailing Address - Fax:863-583-0445
Practice Address - Street 1:5439 WEBER PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4271
Practice Address - Country:US
Practice Address - Phone:863-670-0089
Practice Address - Fax:863-583-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health