Healthcare Provider Details

I. General information

NPI: 1285848358
Provider Name (Legal Business Name): UNIVERSITY OF NOTRE DAME HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SAINT LIAM HALL
NOTRE DAME IN
46556-5612
US

IV. Provider business mailing address

107 SAINT LIAM HALL
NOTRE DAME IN
46556-5612
US

V. Phone/Fax

Practice location:
  • Phone: 574-631-6574
  • Fax: 574-631-3874
Mailing address:
  • Phone: 574-631-6574
  • Fax: 574-631-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number60005298A
License Number StateIN

VIII. Authorized Official

Name: ANN KLEVA
Title or Position: DIRECTOR
Credential:
Phone: 574-631-8286