Healthcare Provider Details

I. General information

NPI: 1215058151
Provider Name (Legal Business Name): MIDWEST CENTER FOR YOUTH & FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 W INDIANA ST
KOUTS IN
46347-9703
US

IV. Provider business mailing address

1012 W INDIANA ST
KOUTS IN
46347-9703
US

V. Phone/Fax

Practice location:
  • Phone: 219-766-2999
  • Fax: 219-766-2514
Mailing address:
  • Phone: 219-766-2999
  • Fax: 219-766-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number60004996A
License Number StateIN

VIII. Authorized Official

Name: MISS THOMAS N. BARNETT
Title or Position: PHARMACIST
Credential: RPH
Phone: 219-766-2999