# LOGAN COMMUNITY RESOURCES, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1891917449
- **Authorized official:** MR. CLINT BOLSER (CEO)
- **Authorized official phone:** (574) 289-4831

## Contact information

- **Practice address:** 2505 E. JEFFERSON BLVD, SOUTH BEND, IN 46615
- **Practice address phone:** (574) 289-4831
- **Practice address fax:** (574) 234-2075
- **Mailing address:** 2505 E. JEFFERSON BLVD, SOUTH BEND, IN 46615
- **Mailing address phone:** (574) 289-4831
- **Mailing address fax:** (574) 234-2075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | — | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | — | — |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100108330 | — | IN |
| 05 | — | 201036530 | — | IN |