Organization
FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN A JARRELL (EXECUTIVE DIRECTOR CEO)
(260) 744-4326
Entity
Organization
Contact information
Practice address
2712 S CALHOUN ST, FORT WAYNE, IN 46807-1402
(260) 744-4326
(260) 744-0188
Mailing address
2712 S CALHOUN ST, FORT WAYNE, IN 46807-1402
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8020ASR
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200090360
—
IN
Enumeration date
01/25/2007
Last updated
09/07/2017
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