Provider Demographics
NPI:1578234902
Name:AMS OF WISCONSIN-JANESVILLE, LLC
Entity Type:Organization
Organization Name:AMS OF WISCONSIN-JANESVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-301-3070
Mailing Address - Street 1:1312 BARBERRY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0589
Mailing Address - Country:US
Mailing Address - Phone:608-758-1944
Mailing Address - Fax:608-758-1960
Practice Address - Street 1:1312 BARBERRY DR STE 110
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0589
Practice Address - Country:US
Practice Address - Phone:608-758-1944
Practice Address - Fax:608-758-1960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMS OF WISCONSIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone