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General NPI Number Information
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NPI Number | 1144380163
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Entity Type | Organization
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Legal Business Name | THE CENTRE LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 611 E DOUGLAS RD STE 108A
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City | MISHAWAKA
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State | IN
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Zip | 46545-1464
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Country | US
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Telephone | 574-296-9100
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Fax | 574-243-1141
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Provider Business Mailing Address
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Address Line | 611 E DOUGLAS RD STE 108A
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City | MISHAWAKA
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State | IN
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Zip | 46545-1464
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Country | US
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Telephone | 574-296-9100
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Fax | 574-243-1141
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAIN R DOWNS
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Credential |
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Telephone | 574-296-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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