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General NPI Number Information
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NPI Number | 1477463305
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Entity Type | Organization
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Legal Business Name | PURE MIND, LLC
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 538 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2052
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Country | US
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Telephone | 772-404-7642
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Fax | 773-303-3434
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Provider Business Mailing Address
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Address Line | 538 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2052
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Country | US
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Telephone | 772-404-7642
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Fax | 773-303-3434
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | CHRISTOPHER HALL
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Credential |
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Telephone | 772-404-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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