Organization
PARK CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRIS BIGELOW (DIRECTOR ENTERPRISE CREDENTIALING &)
(260) 266-1403
Entity
Organization
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2717
Mailing address
11109 PARKVIEW PLAZA DRIVE, MAILBOX 117, FORT WAYNE, IN 46845
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
419-0-CMHC
IN
261QP2300X
Primary Care Clinic/Center
—
IN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100463190 C
—
IN
05
—
100463190A
—
IN
05
—
100463190B
—
IN
01
—
300015906
ADDICTION SERVICES
IN
01
—
300024898
ADDICTION SERVICES
IN
Enumeration date
05/15/2006
Last updated
10/29/2021
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