| Northeastern Center | |
|
220 S Main St Kendallville IN 46755-1718 | |
| (260) 347-2453 | |
| (260) 347-2456 |
| Full Name | Northeastern Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 220 S Main St, Kendallville, Indiana |
| Authorized Official Name and Position | Jerry Hollister (CEO) |
| Authorized Official Contact | 2603472453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeastern Center Po Box 817 Kendallville IN 46755-0817 Ph: (260) 347-2453 | Northeastern Center 220 S Main St Kendallville IN 46755-1718 Ph: (260) 347-2453 |
| NPI Number | 1174685358 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174685358 | NPI | - | NPPES |
| 100190820B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 426-0-CMHC (Indiana) | Primary |
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