Park Center Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Fort Wayne, IN
NPI 1306897004 · NPPES record last updated Oct 29, 2021
Key facts
- NPI
- 1306897004
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- License
- 419-0-CMHC (IN)
- Legal business name
- PARK CENTER INC
- Practice address
- 909 E State Blvd
Fort Wayne, IN 46805-3404 - Phone
- (260) 481-2700
- Fax
- (260) 481-2717
- NPI assigned
- May 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Kris Bigelow
- Title
- Director Enterprise Credentialing &
- Phone
- (260) 266-1403
Other NPIs with the same Medicare PAC ID 1
Member of 1
Practitioners 115
-
Janet Baker Anderson, RN FNP
-
Sean P Andes, MS
-
Jinny Renee Broderick, LCSW
-
Marjorie L Burns, LCSW, MSSW
-
Kaitlyn Joy Chittick-Myers, PMHNP
-
Chelsea Crago, LSW
-
Melissa Sue Finefrock, LMFT
-
Brian K Flesch, MSW, LCSW
-
Jessica Gabbard, LMHCA (TEMP)
-
Melodie A Gavin, RN
-
Ganit Anna Gray, LCSW
-
Sean Hall, LMHC
-
Rebecca L Haynes, NP
-
Deepak Khemka, M.D.
-
Sandra J Klinker, MSW, ACSW
-
Karen S Lothamer, RN, CNS
-
Ahsan Mahmood, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041213000226 | IN | Part B Supplier - Clinic/Group Practice | 5991794794 |
Receives reassigned benefits from 99 practitioners Practice locations: Decatur, IN; Huntington, IN; Fort Wayne, IN; Columbia City, IN; Bluffton, IN |
National Provider Directory
Locations
8202 Glencarin Blvd
Ste 230
Fort Wayne, IN 46804
Phone (260) 425-4100
11109 Parkview Plaza Dr
Ste 117
Fort Wayne, IN 46845
1610 Spy Run Ave
Fort Wayne, IN 46805
Phone (260) 423-2502
26 Victory Noll Dr
Huntington, IN 46750
Phone (260) 355-3730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist |
103TA0400X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 419-0-CMHC | IN | Yes |
| Primary Care Clinic/Center | 261QP2300X | IN | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
909 E State Blvd
Fort Wayne, IN 46805-3404
Mailing address
11109 Parkview Plaza Drive
Mailbox 117
Fort Wayne, IN 46845
Phone (260) 373-9700
Other practice location 1
1610 Spy Run Ave
Fort Wayne, IN 46805-4033
Phone (260) 432-2502
Other practice location 2
1909 Carew St
Fort Wayne, IN 46805-4707
Phone (260) 481-2800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100463190 C | Medicaid | IN | |
| 100463190B | Medicaid | IN | |
| 300015906 | Other | IN | ADDICTION SERVICES |
| 100463190A | Medicaid | IN | |
| 300024898 | Other | IN | ADDICTION SERVICES |
Other providers in Fort Wayne, IN
- Maren M. Parent
- Virendra A. Parikh
- David J. Paris
- Steven Michael Paris
- Park Center Inc
- Park Center Inc
- Park Center, Inc.
- Park Place Senior Living, LLC
- Lawrence Eugene Park
- Alexis Parker
All providers in Fort Wayne, IN · Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.