Provider Demographics
NPI:1215242565
Name:AMI, INC OF WASHINGTON-GREENE COUNTIES
Entity type:Organization
Organization Name:AMI, INC OF WASHINGTON-GREENE COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPRP
Authorized Official - Phone:878-212-3927
Mailing Address - Street 1:907 JEFFERSON AVE.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3824
Mailing Address - Country:US
Mailing Address - Phone:724-228-5211
Mailing Address - Fax:724-228-6321
Practice Address - Street 1:907 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3824
Practice Address - Country:US
Practice Address - Phone:724-228-5211
Practice Address - Fax:724-228-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA42400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025456920001Medicaid
PA1025456920006Medicaid
PA1025456920007Medicaid