Provider Demographics
NPI:1538941497
Name:GREENSTAFF MEDICAL HOME CARE LLC
Entity type:Organization
Organization Name:GREENSTAFF MEDICAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:CASH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-964-5382
Mailing Address - Street 1:3597 E MONARCH SKY LN # F-240
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1053
Mailing Address - Country:US
Mailing Address - Phone:208-781-6282
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LN # F-240
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1053
Practice Address - Country:US
Practice Address - Phone:208-781-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENSTAFF HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care