Provider Demographics
NPI:1598099384
Name:GREEN HEALTH ALTERNATIVE CARE CENTER
Entity Type:Organization
Organization Name:GREEN HEALTH ALTERNATIVE CARE CENTER
Other - Org Name:GREEN HEALTH ACC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RIDDLE-LUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-420-4739
Mailing Address - Street 1:950 E VISTA WAY STE A2
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 E VISTA WAY STE A2
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5252
Practice Address - Country:US
Practice Address - Phone:877-420-4739
Practice Address - Fax:888-550-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty