Provider Demographics
NPI:1215704143
Name:ACCESS GREENADINE LLC
Entity type:Organization
Organization Name:ACCESS GREENADINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:NICOLA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-995-2936
Mailing Address - Street 1:112 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-2204
Mailing Address - Country:US
Mailing Address - Phone:860-995-2936
Mailing Address - Fax:
Practice Address - Street 1:112 EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2204
Practice Address - Country:US
Practice Address - Phone:860-995-2936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)