MEDICARE: COUNTY OF GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679699482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF GREENE

Provider Business Mailing Address
First Line	:	19 S WASHINGTON ST
Second Line	:	3RD FLOOR FORT JACKSON BUILDING
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-2053
Country	:	US
Telephone Number	:	724-852-5276
Fax Number	:	724-852-5368

Provider Business Practice Location Address
First Line	:	19 S WASHINGTON ST
Second Line	:	3RD FLOOR FORT JACKSON BUILDING
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-2053
Country	:	US
Telephone Number	:	724-852-5276
Fax Number	:	724-852-5368

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KAREN BENNETT
Credential	:
Telephone Number	:	724-852-5276

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/11/2025

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Directions to “COUNTY OF GREENE ” Practice Location

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