Organization
FORT WAYNE CLUBHOUSE, INC
Active
Organization
FORT WAYNE CLUBHOUSE, INC
Active
Other names
The Carriage House
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEXANDER CHARLES WILSON MTS (EXECUTIVE DIRECTOR)
(260) 414-8164
Entity
Organization
Contact information
Practice address
3327 LAKE AVE, FORT WAYNE, IN 46805-5529
(260) 414-8164
(260) 423-4621
Mailing address
3327 LAKE AVE, FORT WAYNE, IN 46805-5529
(260) 414-8164
(260) 423-4621
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/18/2016
Last updated
03/18/2016
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