Provider Demographics
NPI:1699007831
Name:GREENFELDER, MICHAEL (QMHS - 3)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GREENFELDER
Suffix:
Gender:M
Credentials:QMHS - 3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CROSS ST
Mailing Address - Street 2:COMMUNITY SUPPORT SERVICES, INC.
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1047
Mailing Address - Country:US
Mailing Address - Phone:330-253-9388
Mailing Address - Fax:330-253-0377
Practice Address - Street 1:150 CROSS ST
Practice Address - Street 2:COMMUNITY SUPPORT SERVICES, INC.
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1047
Practice Address - Country:US
Practice Address - Phone:330-253-9388
Practice Address - Fax:330-253-0377
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN196294163WP0809X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN196294OtherOHIO STATE BOARD OF NURSING