Green Beret Healthcare Agency, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GREEN BERET HEALTHCARE AGENCY, INC

Practice address

1014 Harvest Grove CT
Hope Mills, NC 28348-9272

Phone

(910) 364-5219

Fax

(866) 704-9129

NPI assigned

Apr 9, 2019

Organization subpart

No

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

Authorized official

Name

Timmy Mack

Title

Director

Phone

(910) 364-5219

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Danielle Mack

  • Home Health Registered Nurse
  • Hope Mills, NC
  • NPI 1306305248
  NPD (past)

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1376006130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 HARVEST GROVE CT",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283489272",
            "telephone_number": "910-364-5219",
            "fax_number": "866-704-9129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 HARVEST GROVE CT",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283489272",
            "telephone_number": "910-364-5219",
            "fax_number": "866-704-9129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BERET HEALTHCARE AGENCY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "TIMMY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-364-5219"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6602223",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Debnam Gonzalez
• Tad Gow, RN
• Deznique Graham
• Francisca Silva Graham, RN
• Great Expectations Mental Health Services, Inc.
• Delisa Michelle Grimes
• Felicia Ann Grinie
• Guardian Angel Transportation
• Dr. Subodh Gurung, D.M.D
• Garrett Dwayne Gwin

• Home Health Agency in Hope Mills, NC
• Providers in Hope Mills, NC by specialty
• Home Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.