Organization
GREEN LIFE ENHANCEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PORSCHA NICOLE GREEN QP (OWNER/CEO)
(984) 664-2437
Entity
Organization
Contact information
Practice address
1220 ARAGON DR APT 101, KNIGHTDALE, NC 27545-6027
(984) 664-2437
Mailing address
PO BOX 41113, RALEIGH, NC 27629-1113
(984) 664-2437
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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