Provider Demographics
NPI:1790145902
Name:VILLAGE GREEN ANGELS, LLC
Entity Type:Organization
Organization Name:VILLAGE GREEN ANGELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NISHREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POONAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-865-7015
Mailing Address - Street 1:9111 KATY FWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3302
Practice Address - Country:US
Practice Address - Phone:936-760-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health