Provider Demographics
NPI:1548796626
Name:GREEN MEADOW HOMES, INC.
Entity Type:Organization
Organization Name:GREEN MEADOW HOMES, INC.
Other - Org Name:GREEN MEADOW HOMES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:NUNAG
Authorized Official - Last Name:LAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-338-8760
Mailing Address - Street 1:2340 PLAZA DEL AMO SUITE 235
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-782-1002
Mailing Address - Fax:310-782-1003
Practice Address - Street 1:2460 W. 229TH STREET
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:424-378-1101
Practice Address - Fax:424-378-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility