Organization
JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA YOUNG (EXECUTIVE DIRECTOR)
(260) 726-7931
Entity
Organization
Contact information
Practice address
901 E WATER ST, PORTLAND, IN 47371-2038
(260) 726-7931
(260) 726-8184
Mailing address
901 E WATER ST, PORTLAND, IN 47371-2038
(260) 726-7931
(260) 726-8184
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
2623B0006JN06
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
2623I0004JN07
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2623I0005JN06
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
2623T0003JN07
IN
Other
Enumeration date
05/19/2006
Last updated
08/22/2020
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