Provider Demographics
NPI:1750990537
Name:GREEN ROAD BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:GREEN ROAD BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:216-297-2053
Mailing Address - Street 1:3295 GLENCAIRN RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3407
Mailing Address - Country:US
Mailing Address - Phone:216-702-5542
Mailing Address - Fax:
Practice Address - Street 1:1611 S GREEN RD STE 303
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4192
Practice Address - Country:US
Practice Address - Phone:216-297-2053
Practice Address - Fax:216-297-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0681169Medicaid