Organization
GREEN SUPPORTIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARDAI GREEN (MEMBER-LLC)
(215) 528-2926
Entity
Organization
Contact information
Practice address
708 E SHARPNACK ST, PHILA, PA 19119-1535
(215) 528-2926
Mailing address
708 E SHARPNACK ST, PHILA, PA 19119-1535
(215) 528-2926
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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