Green Tree Residence LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GREEN TREE RESIDENCE LLC

Practice address

13741 Burning Tree Dr
Victorville, CA 92395-4806

Phone

(760) 245-2504

NPI assigned

Mar 24, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Martin Michael Ventress Jr.

Title

Ceo

Phone

(424) 634-0093

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1184425092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13741 BURNING TREE DR",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923954806",
            "telephone_number": "760-245-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13741 BURNING TREE DR",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923954806",
            "telephone_number": "760-245-2504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN TREE RESIDENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "VENTRESS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "424-634-0093",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Victorville, CA
• Providers in Victorville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.