Provider Demographics
NPI:1285178178
Name:GREEN CROSS CLINIC LLC
Entity type:Organization
Organization Name:GREEN CROSS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALESSANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-239-2051
Mailing Address - Street 1:730 SE 8TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5646
Mailing Address - Country:US
Mailing Address - Phone:305-557-3444
Mailing Address - Fax:
Practice Address - Street 1:730 SE 8TH ST STE 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5646
Practice Address - Country:US
Practice Address - Phone:305-557-3444
Practice Address - Fax:305-557-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018864900Medicaid