Provider Demographics
NPI:1811412604
Name:AMA TRANSITIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:AMA TRANSITIONAL SERVICES, LLC
Other - Org Name:AMA TRANSITIONAL SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:716-465-6832
Mailing Address - Street 1:1407 LOCHNER RD STE 0
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2932
Mailing Address - Country:US
Mailing Address - Phone:443-475-0338
Mailing Address - Fax:410-561-1751
Practice Address - Street 1:1407 LOCHNER RD STE 0
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2932
Practice Address - Country:US
Practice Address - Phone:443-475-0338
Practice Address - Fax:410-561-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4829261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1215103544Medicaid