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Organization

GREAT I AM WELFARE AND DEVELOPMENT HOME HEALTH AGENCY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARROLL A GREEN SR. (OWNER)
90932920334
Entity
Organization

Contact information

Practice address
14189 FOOTHILL BLVD, 102, FONTANA, CA 92335-3093
(909) 329-3024
Mailing address
14189 FOOTHILL BLVD, 102, FONTANA, CA 92335-3093
(909) 329-3024

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
201312310016
CA

Other

Enumeration date
05/09/2013
Last updated
07/01/2013
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