Clubhouse of Saint Joseph County

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

CLUBHOUSE OF SAINT JOSEPH COUNTY

Practice address

1216 Wayne St N
South Bend, IN 46615-1036

Phone

(574) 360-8409

Fax

(574) 966-1443

NPI assigned

Jul 26, 2016

Last updated

Jul 26, 2016By 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

Mark Dale Buchanan

Title

Executive Director

Phone

(574) 360-8409

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1649723628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 OSTEMO PL",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171023",
            "telephone_number": "574-360-8409",
            "fax_number": "574-966-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 WAYNE ST N",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466151036",
            "telephone_number": "574-360-8409",
            "fax_number": "574-966-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUBHOUSE OF SAINT JOSEPH COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "BUCHANAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "574-360-8409"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Voluntary or Charitable Agency in South Bend, IN
• Providers in South Bend, IN by specialty
• Voluntary or Charitable Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; 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.