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NPI Code Detail

MEDICARE: THE ARC OF NORTHEAST INDIANA INC.

MEDICARE: THE ARC OF NORTHEAST INDIANA INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility2602B0009JN05IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417019241
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE ARC OF NORTHEAST INDIANA INC.
Provider Business Mailing Address
First Line : 4919 COLDWATER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5532
Country : US
Telephone Number : 260-456-4534
Fax Number : 260-745-5200
Provider Business Practice Location Address
First Line : 2524 BEECHWOOD CIR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1201
Country : US
Telephone Number : 260-456-4534
Fax Number : 260-745-5200
Authorized Official
Title or Position : PRESIDENT
Name : MS. DONNA ELBRECHT
Credential :
Telephone Number : 260-456-4534
Provider Enumeration Date : 12/15/2006
Last Update Date : 02/25/2021

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