Greene Wellness And Rehab Center LLC.
Exclusive Provider Organization in Revere, MA. Organization (NPI-2).
NPI number1982158374
StatusActive
Last updated in NPPESAug 15, 2016
Details
- NPI
- 1982158374
- Entity type
- Organization (NPI-2)
- Legal business name
- Greene Wellness And Rehab Center LLC.
- Organization subpart
- No
- Enumeration date
- Aug 15, 2016
- Last updated
- Aug 15, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | 692 | MA | Yes |
Practice location
708 BroadwayRevere, MA 02151-2334
Phone 781-284-4001 · Fax 781-284-4116
Mailing address
708 BroadwayRevere, MA 02151-2334
Phone 781-284-4001 · Fax 781-284-4116
Authorized official
Richie Hernandez
Manager
7812844001
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