Provider Demographics
NPI:1922400605
Name:GREEN HOUSE CARE INC
Entity Type:Organization
Organization Name:GREEN HOUSE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZICHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:818-212-5085
Mailing Address - Street 1:16011 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4806
Mailing Address - Country:US
Mailing Address - Phone:818-212-5085
Mailing Address - Fax:818-908-0894
Practice Address - Street 1:16011 BASSETT ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4806
Practice Address - Country:US
Practice Address - Phone:818-212-5085
Practice Address - Fax:818-908-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility