Organization
GREEN HAVEN ADULT DAY PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY DANIELLE GREEN (PROGRAM DIRECTOR)
(314) 393-1639
Entity
Organization
Contact information
Practice address
6207 N LINDBERGH BLVD, HAZELWOOD, MO 63042-2817
(314) 393-1639
Mailing address
914 TIMBERWOOD CROSSING CT, FLORISSANT, MO 63031-7518
(314) 393-1639
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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