# INDIANA DEVELOPMENTAL TRAINING CENTER OF LAFAYETTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114056074
- **Authorized official:** MS. M DEBORAH FRISK MSW (VICE PRESIDENT)
- **Authorized official phone:** (262) 569-5515

## Contact information

- **Practice address:** 3700 ROME DRIVE, LAFAYETTE, IN 47905
- **Practice address phone:** (765) 448-4220
- **Practice address fax:** (765) 488-4217
- **Mailing address:** PO BOX 278, DOUSMAN, WI 53118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | IN | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020