Organization
TERRACEDAR SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONCHELLE DENISE DAVIS (CEO/HABILITATION SPECIALIST)
(260) 310-9599
Entity
Organization
Contact information
Practice address
9317 MADINA PKWY, FORT WAYNE, IN 46825-1134
(260) 310-9599
Mailing address
9317 MADINA PKWY, FORT WAYNE, IN 46825-1134
(260) 310-9599
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
09/24/2019
Last updated
04/13/2022
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