Provider Demographics
NPI:1528641214
Name:GREEN CROSS FOUNDATION INC.
Entity type:Organization
Organization Name:GREEN CROSS FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIDEBELU-EZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC,MS
Authorized Official - Phone:404-671-9564
Mailing Address - Street 1:3421 LEE RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5621
Mailing Address - Country:US
Mailing Address - Phone:317-641-2026
Mailing Address - Fax:
Practice Address - Street 1:418 E 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3909
Practice Address - Country:US
Practice Address - Phone:317-641-2026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335G00000XSuppliersMedical Foods Supplier
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital