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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