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Individual

GEORGE GREENE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DSP

Contact information

Practice address
3946 BING CT, INDIANAPOLIS, IN 46237-3810
(317) 652-6112
Mailing address
3946 BING CT, INDIANAPOLIS, IN 46237-3810
(317) 652-6112

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0
NONE
IN
Enumeration date
03/07/2023
Last updated
03/07/2023
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