Provider Demographics
NPI:1396242152
Name:AMA TRANSITIONAL SERVICES, LLC
Entity type:Organization
Organization Name:AMA TRANSITIONAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-475-0338
Mailing Address - Street 1:22 W PADONIA RD STE A203
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2277
Mailing Address - Country:US
Mailing Address - Phone:443-475-0338
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD STE A203
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2277
Practice Address - Country:US
Practice Address - Phone:443-475-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMA TRANSITIONAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD086022100Medicaid