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NPI Code Detail

MEDICARE: SAMARITAN FAMILY HEALTH AND COUNSELING CENTER, INC.

MEDICARE: SAMARITAN FAMILY HEALTH AND COUNSELING 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1861721136
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMARITAN FAMILY HEALTH AND COUNSELING CENTER, INC.
Provider Business Mailing Address
First Line : 17195 CLEVELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1415
Country : US
Telephone Number : 574-277-0274
Fax Number : 574-271-7202
Provider Business Practice Location Address
First Line : 17195 CLEVELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1415
Country : US
Telephone Number : 574-277-0274
Fax Number : 574-271-7202
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. MARIE BLUNT
Credential : M.MIN.
Telephone Number : 574-277-0274
Provider Enumeration Date : 12/16/2009
Last Update Date : 12/16/2009

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