Provider Demographics
NPI:1588275432
Name:GREEN LIFE ENHANCEMENT SERVICES
Entity type:Organization
Organization Name:GREEN LIFE ENHANCEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:984-664-2437
Mailing Address - Street 1:PO BOX 41113
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1113
Mailing Address - Country:US
Mailing Address - Phone:984-664-2437
Mailing Address - Fax:
Practice Address - Street 1:1220 ARAGON DR APT 101
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6027
Practice Address - Country:US
Practice Address - Phone:984-664-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management