NPIMap

Organization Active NPI

Northeastern Center

  • Community/Behavioral Health Agency
  • Kendallville, IN
National Provider Identifier
1174685358
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
426-0-CMHC Issued in IN
Legal business name
NORTHEASTERN CENTER
Practice address
220 S Main St
Kendallville, IN 46755-1718
Phone
(260) 347-2453
Fax
(260) 347-2456
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Jerry Hollister
Title
Ceo
Phone
(260) 347-2453

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 426-0-CMHC IN Primary

Addresses

Primary practice location

220 S Main St
Kendallville, IN 46755-1718

Mailing address

PO Box 817
Kendallville, IN 46755-0817
Phone (260) 347-2453

Other identifiers 1

IdentifierTypeStateIssuer
100190820BMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Northeastern Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1174685358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 817",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467550817",
            "telephone_number": "260-347-2453",
            "fax_number": "260-347-2456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S MAIN ST",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467551718",
            "telephone_number": "260-347-2453",
            "fax_number": "260-347-2456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "HOLLISTER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-347-2453"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "426-0-CMHC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100190820B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kendallville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.