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Organization
LIFELINE YOUTH & FAMILY SERVICES, INC.
Active
Organization
LIFELINE YOUTH & FAMILY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J. MARTIN (CHIEF FINANCIAL OFFICER)
(260) 745-3322
Entity
Organization
Contact information
Practice address
27 PEQUIGNOT DRIVE, PIERCETON, IN 46562-9075
(260) 745-3322
Mailing address
PO BOX 80487, FORT WAYNE, IN 46898-0487
(260) 745-3322
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200847300
—
IN
05
—
200847310
—
IN
Enumeration date
10/16/2007
Last updated
04/10/2009
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