Green Life Assisted Living Facility, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12577 Issued in FL

Legal business name

GREEN LIFE ASSISTED LIVING FACILITY, LLC

Practice address

840 SW 8TH St
Pompano Beach, FL 33060-8214

Phone

(855) 331-6615

Fax

(855) 638-4902

NPI assigned

Oct 29, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mari Clark

Title

Ceo

Phone

(813) 931-1433

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1124423470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 SW 8TH ST",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330608214",
            "telephone_number": "855-331-6615",
            "fax_number": "855-638-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 SW 8TH ST",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330608214",
            "telephone_number": "855-331-6615",
            "fax_number": "855-638-4902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LIFE ASSISTED LIVING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-29",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MARI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-931-1433",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013937500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Court Alf LLC
• Grand Court W Opco LLC
• Jill S Grant, MSW
• Nakeithia Grant
• Corinne Grasso
• Julie Green
• Kelli Green, B.S.
• Lillian Green
• Sandra Green, E-RYT 200 YOGA TEACH
• Ashley Greenbacker

• Assisted Living Facility in Pompano Beach, FL
• Providers in Pompano Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.