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General NPI Number Information
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NPI Number | 1295507788
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Entity Type | Individual
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Provider Name | RENE LEBLANC III CAPRC I
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Gender | Male
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 5655 S 400 W
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City | BERNE
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State | IN
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Zip | 46711-9519
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Country | US
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Telephone | 260-301-4501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | BERNE
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State | IN
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Zip | 46711-0222
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Country | US
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Telephone | 260-301-4501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CAPRC1-5822
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License Number State | IN
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