Provider Demographics
NPI:1447094784
Name:GREEN TREE WELLNESS LLC
Entity type:Organization
Organization Name:GREEN TREE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-261-8679
Mailing Address - Street 1:9466 CUYAMACA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5923
Mailing Address - Country:US
Mailing Address - Phone:858-304-4030
Mailing Address - Fax:
Practice Address - Street 1:6681 MAGNOLIA AVE STE C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2900
Practice Address - Country:US
Practice Address - Phone:858-304-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management