Organization
A.I.D. RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA KINNALEY MA (PROGRAM ADMINISTRATOR)
(260) 444-3433
Entity
Organization
Contact information
Practice address
10319 DAWSONS CREEK BLVD STE E, FORT WAYNE, IN 46825-1911
(260) 414-4713
Mailing address
10319 DAWSONS CREEK BLVD STE E, FORT WAYNE, IN 46825-1911
(260) 414-4713
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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