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General NPI Number Information
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NPI Number | 1699820720
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Entity Type | Organization
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Legal Business Name | FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 2712 S CALHOUN ST
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City | FORT WAYNE
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State | IN
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Zip | 46807-1402
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Country | US
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Telephone | 260-744-4326
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Fax | 260-744-0188
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Provider Business Mailing Address
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Address Line | 2712 S CALHOUN ST
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City | FORT WAYNE
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State | IN
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Zip | 46807-1402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR CEO
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Name | MR. STEPHEN A JARRELL
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Credential |
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Telephone | 260-744-4326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8020ASR
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License Number State | IN
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