Organization
GREEN TREE RESIDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN MICHAEL VENTRESS JR. (CEO)
(424) 634-0093
Entity
Organization
Contact information
Practice address
13741 BURNING TREE DR, VICTORVILLE, CA 92395-4806
(760) 245-2504
Mailing address
13741 BURNING TREE DR, VICTORVILLE, CA 92395-4806
(760) 245-2504
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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