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Organization
GREEN HAVEN ADULT DAY PROGRAM LLC
Active
Organization
GREEN HAVEN ADULT DAY PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY DANIELLE GREEN (PROGRAM DIRECTOR)
(314) 393-1639
Entity
Organization
Contact information
Practice address
6207 N LINDBERGH BLVD, HAZELWOOD, MO 63042-2817
(314) 393-1639
Mailing address
914 TIMBERWOOD CROSSING CT, FLORISSANT, MO 63031-7518
(314) 393-1639
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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