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General NPI Number Information
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NPI Number | 1336454552
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Entity Type | Organization
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Legal Business Name | WERNLE YOUTH & FAMILY TREATMENT CENTER
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 2000 WERNLE RD
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City | RICHMOND
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State | IN
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Zip | 47374-7015
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Country | US
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Telephone | 765-999-2506
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 WERNLE RD P.O. BOX 1386
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City | RICHMOND
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State | IN
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Zip | 47374-7015
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Country | US
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Telephone | 765-999-2506
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DARRELL GORDON
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Credential | MSA, JD, CFRM
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Telephone | 765-939-4552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 525549198 73847
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 510144198 73834
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License Number State | IN
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