| Greene Pak Psychiatric Service Inc | |
|
482 N Detroit St Xenia OH 45385 | |
| (937) 374-6010 | |
| (937) 374-6014 |
| Full Name | Greene Pak Psychiatric Service Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 482 N Detroit St, Xenia, Ohio |
| Authorized Official Name and Position | Mahmood Rahman (OWNER) |
| Authorized Official Contact | 9373746010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greene Pak Psychiatric Service Inc 76 Fordway Dr Ste 2 Vandalia OH 45377 Ph: (937) 890-3139 | Greene Pak Psychiatric Service Inc 482 N Detroit St Xenia OH 45385 Ph: (937) 374-6010 |
| NPI Number | 1124187554 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 12/11/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124187554 | NPI | - | NPPES |
| 0976949 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (Ohio) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (Ohio) | Secondary |
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