MEDICARE: WHITINGTON HOMES & SERVICES FOR CHILDREN AND FAMILIES, 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
1	251S00000X	Community/Behavioral Health Agency
2	253J00000X	Foster Care Agency	56812098 53404	IN
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982912739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITINGTON HOMES & SERVICES FOR CHILDREN AND FAMILIES, INC

Provider Business Mailing Address
First Line	:	2423 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1210
Country	:	US
Telephone Number	:	260-438-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 FAIRFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1210
Country	:	US
Telephone Number	:	260-438-4029
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BETH GULINO
Credential	:	M.S.W., L.C.S.W
Telephone Number	:	260-438-4029

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/19/2024

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