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General NPI Number Information
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NPI Number | 1073405270
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Entity Type | Organization
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Legal Business Name | PARK CENTER INC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 909 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46805-3404
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Country | US
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Telephone | 260-482-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 PRODUCTION RD
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City | FORT WAYNE
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State | IN
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Zip | 46808-1167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACFO
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Name | STANTON RISSER
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Credential |
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Telephone | 260-266-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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