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NPI Code Detail

MEDICARE: FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC

MEDICARE: FAMILY & CHILDRENS SERVICE OF FORT WAYNE 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
1251S00000XCommunity/Behavioral Health Agency8020ASRIN

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 : 1699820720
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC
Provider Business Mailing Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Authorized Official
Title or Position : EXECUTIVE DIRECTOR CEO
Name : MR. STEPHEN A JARRELL
Credential :
Telephone Number : 260-744-4326
Provider Enumeration Date : 01/25/2007
Last Update Date : 09/07/2017

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Directions to “FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC ” Practice Location

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