Basic Information
| Provider Information | |||||||||
| NPI: | 1255592234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREEN HEALTHCARE LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3124 S WELLS ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606163654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129257013 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5130 W JACKSON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606444332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739218000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2008 | ||||||||
| LastUpdateDate: | 06/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUANG | ||||||||
| AuthorizedOfficialFirstName: | SHUWEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3129257013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209003913 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.