Provider Demographics
NPI:1003026642
Name:LOGAN COMMUNITY RESOURCES, INC
Entity Type:Organization
Organization Name:LOGAN COMMUNITY RESOURCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-289-4831
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46624-1049
Mailing Address - Country:US
Mailing Address - Phone:574-289-4831
Mailing Address - Fax:574-234-2075
Practice Address - Street 1:2105 WABASH ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-1138
Practice Address - Country:US
Practice Address - Phone:574-289-4831
Practice Address - Fax:574-234-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities