Provider Demographics
NPI:1578731493
Name:GREEN HEALTHCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GREEN HEALTHCARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-667-2506
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:16 N BRYN MAWR AVE
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-7353
Mailing Address - Country:US
Mailing Address - Phone:610-667-2506
Mailing Address - Fax:610-667-2508
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1948
Practice Address - Country:US
Practice Address - Phone:610-667-2506
Practice Address - Fax:610-667-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD66662L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01824270Medicaid
032188T0AMedicare PIN
032188Medicare PIN
H08033Medicare UPIN