Organization
GREEN TERRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS W GREENE (OWNER)
(229) 985-0905
Entity
Organization
Contact information
Practice address
821 26TH AVE SE, MOULTRIE, GA 31768-6769
(229) 985-0905
(229) 890-8130
Mailing address
821 26TH AVE SE, MOULTRIE, GA 31768-6769
(229) 985-0905
(229) 890-8130
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00744818A
—
GA
Enumeration date
03/28/2007
Last updated
08/22/2020
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