Provider Demographics
NPI:1184277766
Name:JADE GREENE BCBA LLC
Entity type:Organization
Organization Name:JADE GREENE BCBA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-412-8542
Mailing Address - Street 1:5332 GATHERING OAKS CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3420
Mailing Address - Country:US
Mailing Address - Phone:904-412-8542
Mailing Address - Fax:
Practice Address - Street 1:5332 GATHERING OAKS CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-3420
Practice Address - Country:US
Practice Address - Phone:904-412-8542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty