Provider Demographics
NPI:1144075417
Name:GREENE, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MOORE RD APT 3V
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1246
Mailing Address - Country:US
Mailing Address - Phone:440-752-7167
Mailing Address - Fax:
Practice Address - Street 1:216 MOORE RD APT 3V
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1246
Practice Address - Country:US
Practice Address - Phone:440-752-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care