Healthcare Provider Details

I. General information

NPI: 1013121607
Provider Name (Legal Business Name): CHILDPLACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 HWY 62
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

2420 HWY 62
JEFFERSONVILLE IN
47130
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8248
  • Fax: 812-282-3291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIN

VIII. Authorized Official

Name: NATHAN SAMUEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 812-282-8248