GREENE PAK PSYCHIATRIC SERVICE INC (NPI# 1124187554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124187554 |
| Entity Type | Organization |
| Organization Name | GREENE PAK PSYCHIATRIC SERVICE INC |
| Practice Address |
482 N Detroit St Xenia OH 45385 |
| Mailing Address |
76 Fordway Dr Ste 2 Vandalia OH 45377 |
| Practice Telephone | 9373746010 |
| Practice Fax Number | 9373746014 |
| Mailing Telephone | 9378903139 |
| Mailing Fax Number | 9378903111 |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-12-11 |
| Authorized Official Name | MAHMOOD RAHMAN (OWNER) |
| Authorized Official Telephone | 9373746010 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
OH | Ambulatory Health Care Facilities | |
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
OH | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0976949 | 05 |
| Street Address |
482 N DETROIT ST |
| City | XENIA |
| State | OH |
| Zip Code | 45385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174682504 | Phyllis J Lackey | Counselor | 482 N Detroit St, Xenia, OH 45385 | 2006-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689219008 | Ashley Marie Mosher | Registered Nurse | 1728 Dayton Xenia Road, Xenia, OH 45385 | 2019-11-08 |
| 1255892824 | Hart Behavior Group LLC | Behavioral Analyst | 1690 Kingsway Dr, Xenia, OH 45385 | 2019-03-27 |
| 1053814996 | Briana Creamer | Community/Behavioral Health | 673 Sutton Dr, Xenia, OH 45385 | 2018-03-16 |
| 1174031769 | Maggie Ann Weyandt | Social Worker | 380 Bellbrook Ave., Xenia, OH 45385 | 2018-01-17 |
| 1588116362 | Te Carr | Specialist/Technologist | 1200 Us 42 E, Xenia, OH 45385 | 2016-10-27 |
| 1649678400 | Crystal Misner | Occupational Therapy Assistant | 1694 Pawnee Drive, Xenia, OH 45385 | 2014-12-10 |
| 1750627345 | Claudette May Ross | Registered Nurse | 2301 Dundee Drive, Dayton, OH 45385 | 2012-12-31 |
| 1578868386 | Traditions At Xenia | Assisted Living Facility | 695 Wycliffe Dr, Xenia, OH 45385 | 2011-01-26 |
| 1851624720 | Robert T Morrison Md LLC | Internal Medicine | 215 S. Allison Ave., Xenia, OH 45385 | 2009-09-10 |
| 1790945186 | Tracey D Hacker | Licensed Practical Nurse | 1896 Pueblo Dr, Xenia, OH 45385 | 2008-06-10 |
| Find all providers in zip 45385 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| 1255997599 | Jana Bergfeld Lisw LLC | Clinic/Center | 1071 Fishinger Rd Ste 211, Columbus, OH 43221-2301 | 2019-05-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.