Organization
NIHCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATISHA KING (RN CASE MANAGER)
(765) 603-7268
Entity
Organization
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 348-5512
Mailing address
5702 BAYSIDE DR, FORT WAYNE, IN 46815-8529
(260) 348-5512
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
—
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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