MEDICARE: THE ARC OF NORTHEAST INDIANA INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	2602B0010JN05	IN

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

General Provider Information

NPI Number	:	1649333204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC OF NORTHEAST INDIANA INC.

Provider Business Mailing Address
First Line	:	4919 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5532
Country	:	US
Telephone Number	:	260-456-4534
Fax Number	:	260-745-5200

Provider Business Practice Location Address
First Line	:	8626 STAND RIDGE RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6266
Country	:	US
Telephone Number	:	260-456-4534
Fax Number	:	260-745-5200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DONNA ELBRECHT
Credential	:
Telephone Number	:	260-456-4534

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/25/2021

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