| Project Impact Ft.in Inc. | |
|
2200 Lake Ave Ste 105 Fort Wayne IN 46805-5365 | |
| (260) 426-0646 | |
| Not Available |
| Full Name | Project Impact Ft.in Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2200 Lake Ave Ste 105, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kevin Thomas (OFFICER MANAGER) |
| Authorized Official Contact | 2604260646 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Project Impact Ft.in Inc. 2200 Lake Ave Ste 105 Fort Wayne IN 46805-5365 Ph: (260) 426-0646 | Project Impact Ft.in Inc. 2200 Lake Ave Ste 105 Fort Wayne IN 46805-5365 Ph: (260) 426-0646 |
| NPI Number | 1528203437 |
|---|---|
| Provider Enumeration Date | 12/05/2008 |
| Last Update Date | 12/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528203437 | NPI | - | NPPES |
| 200843270 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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