# GREEN LAKES VILLAGE HOME CARE LLC

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

## Provider details

- **NPI number:** 1992387864
- **Authorized official:** TERRON GARNER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 518-2663

## Contact information

- **Practice address:** 1828 WALNUT ST FL 3, KANSAS CITY, MO 64108-1835
- **Practice address phone:** (314) 518-2663
- **Mailing address:** 1828 WALNUT ST FL 3, KANSAS CITY, MO 64108-1835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2021
- **Last updated:** 04/21/2021