Organization
POSSIBILITIES NORTHEAST, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY L MOORE (EXECUTIVE DIRECTOR)
(260) 338-1241
Entity
Organization
Contact information
Practice address
4935 HILLEGAS RD STE 200, FORT WAYNE, IN 46818-1934
(260) 338-1241
Mailing address
PO BOX 80867, FORT WAYNE, IN 46898-0867
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
163WP0200X
Pediatric Registered Nurse
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200354340A
—
IN
05
—
200357910A
—
IN
05
—
200435950A
—
IN
05
—
200724290
—
IN
05
—
200724290A
—
IN
Enumeration date
02/08/2007
Last updated
02/26/2016
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