Healthcare Provider Details

I. General information

NPI: 1780778266
Provider Name (Legal Business Name): TRADEWINDS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 E 83RD PL
MERRILLVILLE IN
46410-6418
US

IV. Provider business mailing address

3198 E 83RD PL
MERRILLVILLE IN
46410-6418
US

V. Phone/Fax

Practice location:
  • Phone: 219-945-0100
  • Fax: 219-940-3369
Mailing address:
  • Phone: 219-945-0100
  • Fax: 219-940-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31000137A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003978A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JON GOLD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 219-945-0100