NPIMap

Organization Active NPI

Indiana Developmental Training Center of Lafayette LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Lafayette, IN
National Provider Identifier
1114056074
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
INDIANA DEVELOPMENTAL TRAINING CENTER OF LAFAYETTE LLC
Practice address
3700 Rome Drive
Lafayette, IN 47905
Phone
(765) 448-4220
Fax
(765) 488-4217
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. M Deborah Frisk, MSW
Title
Vice President
Phone
(262) 569-5515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X IN Primary

Addresses

Primary practice location

3700 Rome Drive
Lafayette, IN 47905

Mailing address

PO Box 278
Dousman, WI 53118

National Provider Directory

National Provider Directory

Locations

3700 Rome Dr
Lafayette, IN 47905
Phone 7654484220 ext. 5410

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114056074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "53118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 ROME DRIVE",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "47905",
            "telephone_number": "765-448-4220",
            "fax_number": "765-488-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA DEVELOPMENTAL TRAINING CENTER OF LAFAYETTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRISK",
        "authorized_official_first_name": "M",
        "authorized_official_middle_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-569-5515",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.