Organization
L.I.F.E. ADULT DAY ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LLOYD J JONES (EXECUTIVE DIRECTOR)
(260) 436-5232
Entity
Organization
Contact information
Practice address
5421 HOMESTEAD RD, FORT WAYNE, IN 46814-4964
(260) 436-5232
(260) 436-9921
Mailing address
5421 HOMESTEAD RD, FORT WAYNE, IN 46814-4964
(260) 436-5232
(260) 436-9921
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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