Healthcare Provider Details

I. General information

NPI: 1538991443
Provider Name (Legal Business Name): OAKLAWN PSYCHIATRIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LAKEVIEW DR
GOSHEN IN
46528-7000
US

IV. Provider business mailing address

330 LAKEVIEW DR
GOSHEN IN
46528-7000
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-1234
  • Fax: 574-537-2652
Mailing address:
  • Phone: 574-533-1234
  • Fax: 574-537-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BARKMAN
Title or Position: CFO
Credential: CPA
Phone: 574-214-5358