Organization
NORTHEASTERN CENTER,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN KAMARA MA,CRC,LPC (AREA DIRECTOR)
12603474400
Entity
Organization
Contact information
Practice address
1930 DOWLING ST, KENDALLVILLE, IN 46755-9436
(126) 034-7440
(126) 034-7312
Mailing address
1930 DOWLING ST, KENDALLVILLE, IN 46755-9436
(126) 034-7440
(126) 034-7312
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
101YM0800X
IN
Other
Enumeration date
06/12/2007
Last updated
08/22/2020
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