Healthcare Provider Details

I. General information

NPI: 1144380163
Provider Name (Legal Business Name): THE CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD STE 108A
MISHAWAKA IN
46545-1464
US

IV. Provider business mailing address

611 E DOUGLAS RD STE 108A
MISHAWAKA IN
46545-1464
US

V. Phone/Fax

Practice location:
  • Phone: 574-296-9100
  • Fax: 574-243-1141
Mailing address:
  • Phone: 574-296-9100
  • Fax: 574-243-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAIN R DOWNS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 574-296-9100