South Bend Residential Care LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SOUTH BEND RESIDENTIAL CARE LLC

Practice address

1602 N Brookfield St
South Bend, IN 46628-3008

Phone

(207) 312-2620

NPI assigned

Jul 8, 2024

Last updated

Jul 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jean Berchmans Nitunga

Title

Ceo

Phone

(207) 312-2620

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1598501793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N BROOKFIELD ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466283008",
            "telephone_number": "207-312-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N BROOKFIELD ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466283008",
            "telephone_number": "207-312-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-07",
        "status": "A",
        "authorized_official_last_name": "NITUNGA",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "BERCHMANS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-312-2620"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in South Bend, IN
• Providers in South Bend, IN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.