| Clubhouse Of Saint Joseph County | |
|
1216 Wayne St N South Bend IN 46615-1036 | |
| (574) 360-8409 | |
| (574) 966-1443 |
| Full Name | Clubhouse Of Saint Joseph County |
|---|---|
| Speciality | Voluntary Or Charitable |
| Location | 1216 Wayne St N, South Bend, Indiana |
| Authorized Official Name and Position | Mark Dale Buchanan (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5743608409 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clubhouse Of Saint Joseph County 525 Ostemo Pl South Bend IN 46617-1023 Ph: (574) 360-8409 | Clubhouse Of Saint Joseph County 1216 Wayne St N South Bend IN 46615-1036 Ph: (574) 360-8409 |
| NPI Number | 1649723628 |
|---|---|
| Provider Enumeration Date | 07/26/2016 |
| Last Update Date | 07/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649723628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251V00000X | Voluntary Or Charitable | (* (Not Available)) | Primary |
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