Provider Demographics
NPI:1598461345
Name:GREEN EMERALD HOME CARE SERVICES
Entity Type:Organization
Organization Name:GREEN EMERALD HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-759-7213
Mailing Address - Street 1:2721 BENCH CIR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-5510
Mailing Address - Country:US
Mailing Address - Phone:404-759-7213
Mailing Address - Fax:
Practice Address - Street 1:2047 GEES MILL RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1359
Practice Address - Country:US
Practice Address - Phone:404-759-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health