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General NPI Number Information
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NPI Number | 1043107717
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Entity Type | Organization
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Legal Business Name | SAMINA RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 3224 MALLARD COVE LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-2883
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Country | US
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Telephone | 260-446-7613
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Fax | 260-400-9985
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Provider Business Mailing Address
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Address Line | 4929 HOAGLAND AVE
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City | FORT WAYNE
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State | IN
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Zip | 46807-3226
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Country | US
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Telephone | 260-446-7613
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Fax | 260-400-9985
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Authorized Official
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Title or Position | OWNER
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Name | TEI FERGUSON
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Credential |
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Telephone | 260-446-7613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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