Provider Demographics
NPI:1144972357
Name:GREENLEAF OUTREACH SERVICES
Entity type:Organization
Organization Name:GREENLEAF OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATYSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:470-977-2747
Mailing Address - Street 1:12461 VETERANS MEMORIAL HWY STE 778
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2025
Mailing Address - Country:US
Mailing Address - Phone:470-977-2747
Mailing Address - Fax:470-427-5443
Practice Address - Street 1:12461 VETERANS MEMORIAL HWY STE 778
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2025
Practice Address - Country:US
Practice Address - Phone:470-977-2747
Practice Address - Fax:472-427-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management