Provider Demographics
NPI:1851144141
Name:GREEN JUJU CORPORATION
Entity Type:Organization
Organization Name:GREEN JUJU CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAHAMLENFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-283-1909
Mailing Address - Street 1:2367 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1409
Mailing Address - Country:US
Mailing Address - Phone:253-283-1909
Mailing Address - Fax:
Practice Address - Street 1:2367 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1409
Practice Address - Country:US
Practice Address - Phone:253-283-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management