Provider Demographics
NPI:1689921777
Name:GREEN ENERGY GROUP
Entity Type:Organization
Organization Name:GREEN ENERGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-299-4378
Mailing Address - Street 1:2703 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2156
Mailing Address - Country:US
Mailing Address - Phone:708-299-4378
Mailing Address - Fax:
Practice Address - Street 1:16643 KEDZIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428
Practice Address - Country:US
Practice Address - Phone:708-299-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149007169305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization