Provider Demographics
NPI:1124645940
Name:GREEN, ZANGELA
Entity type:Individual
Prefix:
First Name:ZANGELA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZANGELA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:615 BROOKLANE DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2588
Mailing Address - Country:US
Mailing Address - Phone:205-808-6381
Mailing Address - Fax:
Practice Address - Street 1:615 BROOKLANE DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2588
Practice Address - Country:US
Practice Address - Phone:205-796-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL253Z00000X, 347C00000X, 174200000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL851491955OtherEIN FOR BUSINESS