Provider Demographics
NPI:1679699482
Name:COUNTY OF GREENE
Entity type:Organization
Organization Name:COUNTY OF GREENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-852-5276
Mailing Address - Street 1:19 S WASHINGTON ST
Mailing Address - Street 2:3RD FLOOR FORT JACKSON BUILDING
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-2053
Mailing Address - Country:US
Mailing Address - Phone:724-852-5276
Mailing Address - Fax:724-852-5368
Practice Address - Street 1:19 S WASHINGTON ST
Practice Address - Street 2:3RD FLOOR FORT JACKSON BUILDING
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-2053
Practice Address - Country:US
Practice Address - Phone:724-852-5276
Practice Address - Fax:724-852-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Not Answered251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007319930003Medicaid
PA1007319930004Medicaid
PA1007319930005Medicaid