Organization
CLUBHOUSE OF SAINT JOSEPH COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DALE BUCHANAN (EXECUTIVE DIRECTOR)
(574) 360-8409
Entity
Organization
Contact information
Practice address
1216 WAYNE ST N, SOUTH BEND, IN 46615-1036
(574) 360-8409
(574) 966-1443
Mailing address
525 OSTEMO PL, SOUTH BEND, IN 46617-1023
(574) 360-8409
(574) 966-1443
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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