| E.d. Treatment Center Llc | |
|
2610 E Jefferson Blvd South Bend IN 46615-2724 | |
| (574) 232-3000 | |
| (574) 236-4409 |
| Full Name | E.d. Treatment Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2610 E Jefferson Blvd, South Bend, Indiana |
| Authorized Official Name and Position | Joe A Hicks (OWNER) |
| Authorized Official Contact | 5742323000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| E.d. Treatment Center Llc 2610 E Jefferson Blvd South Bend IN 46615-2724 Ph: (574) 232-3000 | E.d. Treatment Center Llc 2610 E Jefferson Blvd South Bend IN 46615-2724 Ph: (574) 232-3000 |
| NPI Number | 1548407109 |
|---|---|
| Provider Enumeration Date | 01/19/2009 |
| Last Update Date | 01/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548407109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1029868 (Indiana) | Primary |
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