Provider Demographics
NPI:1457311466
Name:GREENLEAF FAMILY CENTER
Entity Type:Organization
Organization Name:GREENLEAF FAMILY CENTER
Other - Org Name:FAMILY SERVICES OF SUMMIT COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-376-9494
Mailing Address - Street 1:580 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-9910
Mailing Address - Country:US
Mailing Address - Phone:330-376-9494
Mailing Address - Fax:330-376-4525
Practice Address - Street 1:580 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-9910
Practice Address - Country:US
Practice Address - Phone:330-376-9494
Practice Address - Fax:330-376-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098386Medicaid
OHGR9254361Medicare ID - Type Unspecified
OH2098386Medicaid