# GREEN LINE EXPRESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043989288
- **Authorized official:** CHRISTINA PROCACCIANTI PHARMD (FACILITY ADMINISTRATOR)
- **Authorized official phone:** (401) 360-3200

## Contact information

- **Practice address:** 245 MAIN ST, WAKEFIELD, RI 02879-3527
- **Practice address phone:** (401) 360-3500
- **Mailing address:** 245 MAIN ST, WAKEFIELD, RI 02879-3527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/10/2021
- **Last updated:** 09/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01645 | AMBULATORY CARE FACILITY LICENSE | RI |