# WHEATFIELD RESIDENTIAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wheatfield Academy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720763006
- **Authorized official:** ANDREW STROUP (PROGRAM DIRECTOR)
- **Authorized official phone:** (260) 600-9640

## Contact information

- **Practice address:** 12501 IN-49, WHEATFIELD, IN 46392
- **Practice address phone:** (219) 235-9777
- **Mailing address:** 4150 ILLINOIS RD, FORT WAYNE, IN 46804-1208
- **Mailing address phone:** (219) 235-9777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2023
- **Last updated:** 06/15/2023