Provider Demographics
NPI:1306631940
Name:GREENE, TERRY
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18619 APPOLINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1316
Mailing Address - Country:US
Mailing Address - Phone:734-406-5970
Mailing Address - Fax:
Practice Address - Street 1:8410 S SAINT MARTINS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1615
Practice Address - Country:US
Practice Address - Phone:313-342-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No372500000XNursing Service Related ProvidersChore Provider