| The Carriage House | |
|
3327 Lake Ave Fort Wayne IN 46805-5529 | |
| (260) 414-8164 | |
| (260) 423-4621 |
| Full Name | The Carriage House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3327 Lake Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Alexander Charles Wilson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2604148164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Carriage House 3327 Lake Ave Fort Wayne IN 46805-5529 Ph: (260) 414-8164 | The Carriage House 3327 Lake Ave Fort Wayne IN 46805-5529 Ph: (260) 414-8164 |
| NPI Number | 1346601366 |
|---|---|
| Provider Enumeration Date | 03/18/2016 |
| Last Update Date | 03/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346601366 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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