Provider Demographics
NPI:1770887432
Name:GREEN FERN IN-HOME CARE SERVICE
Entity type:Organization
Organization Name:GREEN FERN IN-HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-452-5605
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:30 PLEASANT STREET
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0625
Mailing Address - Country:US
Mailing Address - Phone:603-452-5605
Mailing Address - Fax:603-452-5610
Practice Address - Street 1:30 PLEASANT STREET
Practice Address - Street 2:PLEASANT STREET PROFESSIONAL BUILDING
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818
Practice Address - Country:US
Practice Address - Phone:603-452-5605
Practice Address - Fax:603-452-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care