Provider Demographics
NPI:1801780879
Name:GREEN MOUNTAIN HOME CARE LLC
Entity type:Organization
Organization Name:GREEN MOUNTAIN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-668-8710
Mailing Address - Street 1:810 MOFFAT CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9074
Mailing Address - Country:US
Mailing Address - Phone:303-668-8710
Mailing Address - Fax:
Practice Address - Street 1:810 MOFFAT CT
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9074
Practice Address - Country:US
Practice Address - Phone:303-668-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health