Provider Demographics
NPI:1144439340
Name:GREEN VALLEY CARE CENTER
Entity type:Organization
Organization Name:GREEN VALLEY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:812-495-2341
Mailing Address - Street 1:520 HARRIS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6704
Mailing Address - Country:US
Mailing Address - Phone:502-426-4034
Mailing Address - Fax:
Practice Address - Street 1:3118 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4213
Practice Address - Country:US
Practice Address - Phone:812-495-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN155070314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility