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NPI Code Detail

MEDICARE: PARK CENTER INC

MEDICARE: PARK CENTER 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
1276400000XSubstance Use Disorder Rehabilitation Hospital Unit
2283Q00000XPsychiatric Hospital

General Provider Information

NPI Number : 1457772402
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK CENTER INC
Provider Business Mailing Address
First Line : 909 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-3404
Country : US
Telephone Number : 260-481-2700
Fax Number : 260-481-2709
Provider Business Practice Location Address
First Line : 1909 CAREW ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4707
Country : US
Telephone Number : 260-481-2809
Fax Number : 260-481-2709
Authorized Official
Title or Position : CFO
Name : MRS. JESSICA LEE-HANSEN
Credential :
Telephone Number : 312-388-0125
Provider Enumeration Date : 12/18/2013
Last Update Date : 03/02/2026

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Directions to “PARK CENTER INC ” Practice Location

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