Provider Demographics
NPI:1316720592
Name:GREEN FAMILY MASSAGE LLC
Entity type:Organization
Organization Name:GREEN FAMILY MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MT
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:903-569-4286
Mailing Address - Street 1:621 N FM 312
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-7628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 S FM 2869 STE 5
Practice Address - Street 2:
Practice Address - City:HOLLY LAKE RANCH
Practice Address - State:TX
Practice Address - Zip Code:75765-4974
Practice Address - Country:US
Practice Address - Phone:903-569-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty