Provider Demographics
NPI:1144629106
Name:GREEN WOMAN LLC
Entity type:Organization
Organization Name:GREEN WOMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:281-573-4200
Mailing Address - Street 1:15838 FM 2354 RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEACH CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77523
Mailing Address - Country:US
Mailing Address - Phone:281-573-4200
Mailing Address - Fax:
Practice Address - Street 1:15838 FM 2354 RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEACH CITY
Practice Address - State:TX
Practice Address - Zip Code:77523
Practice Address - Country:US
Practice Address - Phone:281-573-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225700000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization