Provider Demographics
NPI:1902179518
Name:GREENSIDE 25 INCORPORATED
Entity Type:Organization
Organization Name:GREENSIDE 25 INCORPORATED
Other - Org Name:COMPASSIONATE CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-208-5920
Mailing Address - Street 1:2428 KATINA DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7578
Mailing Address - Country:US
Mailing Address - Phone:214-208-5920
Mailing Address - Fax:
Practice Address - Street 1:2428 KATINA DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7578
Practice Address - Country:US
Practice Address - Phone:214-208-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities