Healthcare Provider Details

I. General information

NPI: 1821294265
Provider Name (Legal Business Name): THE SAMARITAN CENTERS OF NORTHEAST INDIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WAYNE ST SUITE 305
FORT WAYNE IN
46802-3608
US

IV. Provider business mailing address

300 W WAYNE ST SUITE 305
FORT WAYNE IN
46802-3608
US

V. Phone/Fax

Practice location:
  • Phone: 260-422-8556
  • Fax: 260-422-8558
Mailing address:
  • Phone: 260-422-8556
  • Fax: 260-422-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIAN M LITZENBERG
Title or Position: MGR OF ADMIN AND CLIENT SEREVICES
Credential:
Phone: 260-657-5682