Organization
NORTHEASTERN CENTER, INC
Active
Other names
Northeastern Center Inpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENEE RUNKLE (ADMINISTRATIVE SERVICES COORDINATOR)
(260) 347-2453
Entity
Organization
Contact information
Practice address
1850 WESLEY RD, AUBURN, IN 46706-3653
(260) 927-0726
(260) 927-0760
Mailing address
PO BOX 817, KENDALLVILLE, IN 46755-0817
(260) 347-2453
(260) 347-2456
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
426-18-PIP
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316878
ANTHEM PROVIDER NUMBER
IN
05
—
200404950
—
IN
Enumeration date
08/25/2006
Last updated
10/24/2013
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