Healthcare Provider Details

I. General information

NPI: 1477549731
Provider Name (Legal Business Name): TRUSTEES OF PURDUE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PRINCE WILLIAM RD SUITE A
DELPHI IN
46923-1759
US

IV. Provider business mailing address

901 PRINCE WILLIAM RD STE A
DELPHI IN
46923-1759
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-3016
  • Fax: 765-564-2608
Mailing address:
  • Phone: 765-564-3016
  • Fax: 765-564-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. DANIEL J. LAYMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-564-3016