Provider Demographics
NPI:1982158374
Name:GREENE WELLNESS AND REHAB CENTER LLC.
Entity Type:Organization
Organization Name:GREENE WELLNESS AND REHAB CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-284-4001
Mailing Address - Street 1:708 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2334
Mailing Address - Country:US
Mailing Address - Phone:781-284-4001
Mailing Address - Fax:781-284-4116
Practice Address - Street 1:708 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-2334
Practice Address - Country:US
Practice Address - Phone:781-284-4001
Practice Address - Fax:781-284-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA692302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization