Provider Demographics
NPI:1649878331
Name:WINTERGREEN SERVICES LLC
Entity type:Organization
Organization Name:WINTERGREEN SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GICHURU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:978-427-4005
Mailing Address - Street 1:9 CENTRAL ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1916
Mailing Address - Country:US
Mailing Address - Phone:978-427-4005
Mailing Address - Fax:978-226-5661
Practice Address - Street 1:130 PARKER ST UNIT 12
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1556
Practice Address - Country:US
Practice Address - Phone:978-427-4005
Practice Address - Fax:978-226-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health