Provider Demographics
NPI:1912570029
Name:GREEN LIGHTENING HEALTHCARE
Entity Type:Organization
Organization Name:GREEN LIGHTENING HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRAILLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-680-6633
Mailing Address - Street 1:4014 E HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3820
Mailing Address - Country:US
Mailing Address - Phone:813-680-6633
Mailing Address - Fax:888-343-9196
Practice Address - Street 1:4014 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3820
Practice Address - Country:US
Practice Address - Phone:813-680-6633
Practice Address - Fax:888-343-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty