Provider Demographics
NPI:1962103580
Name:ADILAH B GREEN LLC
Entity type:Organization
Organization Name:ADILAH B GREEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADILAH
Authorized Official - Middle Name:BURHANA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-992-5557
Mailing Address - Street 1:12434 E 12 MILE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3536
Mailing Address - Country:US
Mailing Address - Phone:586-992-5557
Mailing Address - Fax:586-992-5559
Practice Address - Street 1:12434 E 12 MILE RD STE 102
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3536
Practice Address - Country:US
Practice Address - Phone:586-992-5557
Practice Address - Fax:586-992-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care