Provider Demographics
NPI:1699847301
Name:GREEN CROSS OF PEMBROKE PINES
Entity Type:Organization
Organization Name:GREEN CROSS OF PEMBROKE PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-0633
Mailing Address - Street 1:2645 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2754
Mailing Address - Country:US
Mailing Address - Phone:305-442-0633
Mailing Address - Fax:305-442-9537
Practice Address - Street 1:8301 S PALM DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4535
Practice Address - Country:US
Practice Address - Phone:954-966-7771
Practice Address - Fax:954-966-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-1401Medicare Oscar/Certification