Healthcare Provider Details

I. General information

NPI: 1437237187
Provider Name (Legal Business Name): PUTNAM COUNTY COMPREHENSIVE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S. BLOOMINGTON ST
GREENCASTLE IN
46135-2102
US

IV. Provider business mailing address

630 TENNESSEE ST
GREENCASTLE IN
46135
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-1406
  • Fax:
Mailing address:
  • Phone: 765-653-9763
  • Fax: 765-653-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES N SCHROEDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-653-9763