1952590911 NPI number — LIFELINE YOUTH & FAMILY SERVICES, INC.

Table of content: (NPI 1952590911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952590911 NPI number — LIFELINE YOUTH & FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFELINE YOUTH & FAMILY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952590911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46898-0487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-745-3322
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 PEQUIGNOT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIERCETON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46562-9075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-745-3322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
260-745-3322

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200847310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200847300 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com