Organization
GREENE PAK PSYCHIATRIC SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHMOOD RAHMAN MD (OWNER)
(937) 374-6010
Entity
Organization
Contact information
Practice address
482 N DETROIT ST, XENIA, OH 45385
(937) 374-6010
(937) 374-6014
Mailing address
76 FORDWAY DR, STE 2, VANDALIA, OH 45377
(937) 890-3139
(937) 890-3111
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
OH
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0976949
—
OH
Enumeration date
12/08/2006
Last updated
12/11/2007
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