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General NPI Number Information
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NPI Number | 1568689818
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Entity Type | Organization
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Legal Business Name | JACKSON CENTER FOR CONDUCTIVE EDUCATION INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 802 N SAMUEL MOORE PKWY
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City | MOORESVILLE
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State | IN
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Zip | 46158-1467
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Country | US
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Telephone | 317-834-0200
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Fax | 317-834-0203
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Provider Business Mailing Address
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Address Line | 802 N SAMUEL MOORE PKWY
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City | MOORESVILLE
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State | IN
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Zip | 46158-1467
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Country | US
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Telephone | 317-834-0200
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Fax | 317-834-0203
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Authorized Official
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Title or Position | DEVELOPMENT DIRECTOR
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Name | MRS. MELANIE KAY DEPOY
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Credential |
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Telephone | 317-834-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 1051276
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License Number State | IN
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