NPIMap

Organization Active NPI

Jay-Randolph Developmental Services, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Portland, IN
National Provider Identifier
1831143478
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2623I0005JN06 Issued in IN
Legal business name
JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC.
Practice address
901 E Water St
Portland, IN 47371-2038
Phone
(260) 726-7931
Fax
(260) 726-8184
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Anita Young
Title
Executive Director
Phone
(260) 726-7931

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2623I0005JN06 IN Primary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2623I0004JN07 IN
Intellectual Disabilities Intermediate Care Facility 315P00000X 2623B0006JN06 IN
Intellectual Disabilities Intermediate Care Facility 315P00000X 2623T0003JN07 IN

Addresses

Primary practice location

901 E Water St
Portland, IN 47371-2038

Mailing address

901 E Water St
Portland, IN 47371-2038
Phone (260) 726-7931

National Provider Directory

National Provider Directory

Locations

901 E Water St
Portland, IN 47371
Phone (260) 726-7931

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831143478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E WATER ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473712038",
            "telephone_number": "260-726-7931",
            "fax_number": "260-726-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E WATER ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473712038",
            "telephone_number": "260-726-7931",
            "fax_number": "260-726-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "260-726-7931"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "2623I0005JN06",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "2623I0004JN07",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "2623B0006JN06",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "2623T0003JN07",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.