A.I.D. Residential Services, LLC

Primary specialty

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

Legal business name

A.I.D. RESIDENTIAL SERVICES, LLC

Practice address

10319 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1911

Phone

(260) 414-4713

NPI assigned

Mar 22, 2016

Last updated

Mar 22, 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

Christina Kinnaley, MA

Title

Program Administrator

Phone

(260) 444-3433

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1700248564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10319 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251911",
            "telephone_number": "260-414-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10319 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251911",
            "telephone_number": "260-414-4713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A.I.D. RESIDENTIAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "KINNALEY",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "260-444-3433",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Fort Wayne, IN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.