NPIMap

Organization Active NPI

Logan Community Resources

  • Behavior Analyst
  • South Bend, IN
National Provider Identifier
1639558331
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-15-18324 Issued in IN
Legal business name
LOGAN COMMUNITY RESOURCES
Practice address
2505 E Jefferson Blvd
South Bend, IN 46615-2635
Phone
(574) 289-4831
Fax
(574) 234-2075
NPI assigned
May 27, 2015
Last updated
May 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Authorized official

Name
Mr. Dan Ryan
Title
Dir Sonya Ansari Center for Autism
Phone
(574) 289-4831

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 1-15-18324 IN Primary

Addresses

Primary practice location

2505 E Jefferson Blvd
South Bend, IN 46615-2635

Mailing address

2505 E Jefferson Blvd
South Bend, IN 46615-2635
Phone (574) 289-4831

National Provider Directory

National Provider Directory
Tax ID family
Logan Community Resources14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

2755 E Napier Ave
Benton Harbor, MI 49022

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1639558331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152635",
            "telephone_number": "574-289-4831",
            "fax_number": "574-234-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152635",
            "telephone_number": "574-289-4831",
            "fax_number": "574-234-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN COMMUNITY RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "DIR SONYA ANSARI CENTER FOR AUTISM",
        "authorized_official_telephone_number": "574-289-4831",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "IN",
            "license": "1-15-18324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; 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.