Provider Demographics
NPI:1790078996
Name:GREEN CARE HOMES OF TENNESSEE
Entity Type:Organization
Organization Name:GREEN CARE HOMES OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-667-1155
Mailing Address - Street 1:1103 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3238
Mailing Address - Country:US
Mailing Address - Phone:615-667-1155
Mailing Address - Fax:615-380-8020
Practice Address - Street 1:203 5TH AVE E STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2420
Practice Address - Country:US
Practice Address - Phone:615-380-8974
Practice Address - Fax:615-457-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
TN1000000015615251S00000X
TN1000000020969251S00000X
TN1000000020986251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health