Green Valley Enterprises, Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

1387-800 Issued in WI

Legal business name

GREEN VALLEY ENTERPRISES, INC.

Practice address

1223 Madison St
Beaver Dam, WI 53916-2629

Phone

(920) 887-4282

Fax

(920) 887-4292

NPI assigned

Mar 11, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Jeanine Knudson

Title

Executive Director

Phone

(920) 887-4282

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1891965356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 MADISON ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162629",
            "telephone_number": "920-887-4282",
            "fax_number": "920-887-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 MADISON ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162629",
            "telephone_number": "920-887-4282",
            "fax_number": "920-887-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN VALLEY ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "KNUDSON",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "920-887-4282",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WI",
            "license": "1387-800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41421000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Beaver Dam, WI
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• Case Management Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.