Healthcare Provider Details

I. General information

NPI: 1154531184
Provider Name (Legal Business Name): LOGAN COMMUNITY RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

20089 LARK DR
SOUTH BEND IN
46637-3023
US

IV. Provider business mailing address

PO BOX 1049
SOUTH BEND IN
46624-1049
US

V. Phone/Fax

Practice location:
  • Phone: 574-289-4893
  • Fax: 574-234-2075
Mailing address:
  • Phone: 574-289-4831
  • Fax: 574-234-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL HARSHMAN
Title or Position: CEO
Credential:
Phone: 574-289-4831