| Park Center, Inc. | |
|
909 E State Blvd Fort Wayne IN 46805-3404 | |
| (260) 481-2700 | |
| (260) 481-2717 |
| Full Name | Park Center, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 909 E State Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Stanton Risser (ACFO) |
| Authorized Official Contact | 2602669380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Center, Inc. 909 E State Blvd Fort Wayne IN 46805-3404 Ph: (260) 481-2700 | Park Center, Inc. 909 E State Blvd Fort Wayne IN 46805-3404 Ph: (260) 481-2700 |
| NPI Number | 1053594663 |
|---|---|
| Provider Enumeration Date | 12/06/2007 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053594663 | NPI | - | NPPES |
| 100463190A | Medicaid | IN | |
| 100463190B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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