Active NPI
Melissa Green
- Developmentally Disabled Services Day Training Agency
- Youngstown, OH
National Provider Identifier
1386230654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- License
- 7803324
- Practice address
- 709 Cassius Ave
Youngstown, OH 44505-3464 - Phone
- (330) 717-4460
- NPI assigned
- Dec 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | 7803324 | OH | Primary |
Addresses
Primary practice location
709 Cassius Ave
Youngstown, OH 44505-3464
Mailing address
709 Cassius Ave
Youngstown, OH 44505-3464
Phone (330) 717-4460
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0265879 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7803324 | OH | MD | Developmentally Disabled Services Day Training Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608508800000",
"number": "1386230654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 CASSIUS AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445053464",
"telephone_number": "330-717-4460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 CASSIUS AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445053464",
"telephone_number": "330-717-4460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-21",
"last_updated": "2020-12-21",
"certification_date": "2020-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "OH",
"license": "7803324",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0265879",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Youngstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.