Green Haven Group Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GREEN HAVEN GROUP HOME

Doing business as

Green Haven Group Home

Practice address

3111 Creekwood Dr
Wylie, TX 75098-7339

Phone

(408) 561-2324

NPI assigned

Aug 9, 2023

Organization subpart

No

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

Authorized official

Name

Ali Adem

Title

Manager

Phone

(408) 561-2324

Specialties & licenses 1

Addresses

Other names 1

• Green Haven Group Home Doing business as

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1174206957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 CREEKWOOD DR",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750987339",
            "telephone_number": "408-561-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 CREEKWOOD DR",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750987339",
            "telephone_number": "408-561-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN HAVEN GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "ADEM",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "408-561-2324"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Haven Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Wylie, TX
• Providers in Wylie, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.