Provider Demographics
NPI:1518141357
Name:AMDG SERVICES, INC
Entity Type:Organization
Organization Name:AMDG SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-793-7672
Mailing Address - Street 1:1853 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9553
Mailing Address - Country:US
Mailing Address - Phone:269-793-7672
Mailing Address - Fax:
Practice Address - Street 1:1853 136TH AVE
Practice Address - Street 2:
Practice Address - City:DORR
Practice Address - State:MI
Practice Address - Zip Code:49323-9553
Practice Address - Country:US
Practice Address - Phone:269-793-7672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N80620Medicare PIN