Project Impact Ft.in Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROJECT IMPACT FT.IN INC.

Practice address

2200 Lake Ave Ste 105
Fort Wayne, IN 46805-5365

Phone

(260) 426-0646

NPI assigned

Dec 5, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Thomas

Title

Officer Manager

Phone

(260) 426-0646

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228435200000",
    "number": "1528203437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 LAKE AVE STE 105",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055365",
            "telephone_number": "260-426-0646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 LAKE AVE STE 105",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055365",
            "telephone_number": "260-426-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT IMPACT FT.IN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2008-12-05",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OFFICER MANAGER",
        "authorized_official_telephone_number": "260-426-0646",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200843270",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Community/Behavioral Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.