Organization
MICHIANA MENTAL HEALTH CARE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA STANTON NP-P (OWNER)
(574) 220-7084
Entity
Organization
Contact information
Practice address
210 S RACE ST, MISHAWAKA, IN 46544
(574) 220-7084
Mailing address
14691 COPPER PENNY DR, GRANGER, IN 46530-8304
(574) 220-7084
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
71006282A
IN
3104A0625X
Assisted Living Facility (Mental Illness)
71016282A
IN
310500000X
Mental Illness Intermediate Care Facility
71016282A
IN
314000000X
Skilled Nursing Facility
71016282A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194175554
—
IN
Enumeration date
08/13/2018
Last updated
08/22/2018
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