NPIMap

Organization Active NPI

Family & Childrens Service of Fort Wayne Inc

  • Community/Behavioral Health Agency
  • Fort Wayne, IN
National Provider Identifier
1699820720
Registry record updated Sep 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
8020ASR Issued in IN
Legal business name
FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC
Practice address
2712 S Calhoun St
Fort Wayne, IN 46807-1402
Phone
(260) 744-4326
Fax
(260) 744-0188
NPI assigned
Jan 25, 2007
Last updated
Sep 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2017

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

Authorized official

Name
Mr. Stephen A JarrellNPI 1528105202
Title
Executive Director Ceo
Phone
(260) 744-4326

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 8020ASR IN Primary

Addresses

Primary practice location

2712 S Calhoun St
Fort Wayne, IN 46807-1402

Mailing address

2712 S Calhoun St
Fort Wayne, IN 46807-1402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041021000128 IN Part B Supplier - Clinic/Group Practice 4587625769 Receives reassigned benefits from 4 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

2712 S Calhoun St
Fort Wayne, IN 46807
Phone (219) 744-4326

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504742400000",
    "number": "1699820720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468071402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468071402",
            "telephone_number": "260-744-4326",
            "fax_number": "260-744-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & CHILDRENS SERVICE OF FORT WAYNE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2017-09-07",
        "status": "A",
        "authorized_official_last_name": "JARRELL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR CEO",
        "authorized_official_telephone_number": "260-744-4326",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "8020ASR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.