Provider Demographics
NPI:1790548410
Name:GREEN RIBBON GULF COAST LLC
Entity Type:Organization
Organization Name:GREEN RIBBON GULF COAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:COPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-813-3826
Mailing Address - Street 1:1100 POYDRAS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70163-0100
Mailing Address - Country:US
Mailing Address - Phone:504-813-3826
Mailing Address - Fax:
Practice Address - Street 1:145 ALLEN TOUSSAINT BLVD STE 402
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2578
Practice Address - Country:US
Practice Address - Phone:504-813-3826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty