Provider Demographics
NPI:1598330862
Name:GREEN HEARTS HOMECARE
Entity Type:Organization
Organization Name:GREEN HEARTS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PERSONAL HOME AIDE
Authorized Official - Prefix:
Authorized Official - First Name:BRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-615-5128
Mailing Address - Street 1:3220 BRAEWICK PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6606
Mailing Address - Country:US
Mailing Address - Phone:704-615-5128
Mailing Address - Fax:
Practice Address - Street 1:3220 BRAEWICK PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6606
Practice Address - Country:US
Practice Address - Phone:704-615-5128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care