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General NPI Number Information
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NPI Number | 1346372653
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Entity Type | Organization
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Legal Business Name | PEOPLE OF CONVICTION
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1325 S ANTHONY BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46803-2107
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Country | US
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Telephone | 260-424-3420
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Fax | 260-424-3420
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Provider Business Mailing Address
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Address Line | 1325 S ANTHONY BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46803-2107
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Country | US
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Telephone | 260-424-3420
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Fax | 260-424-3420
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Authorized Official
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Title or Position | EXE DIRECTOR
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Name | DR. SAHARRA L BLEDSOE
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Credential |
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Telephone | 260-424-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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