Provider Demographics
NPI:1295080273
Name:GREEN ENERG, INC
Entity type:Organization
Organization Name:GREEN ENERG, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:EIT
Authorized Official - Phone:248-343-0487
Mailing Address - Street 1:4850 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3936
Mailing Address - Country:US
Mailing Address - Phone:248-343-0487
Mailing Address - Fax:
Practice Address - Street 1:4850 S HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-3936
Practice Address - Country:US
Practice Address - Phone:248-343-0487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN ENERG, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-5124103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty