Provider Demographics
NPI:1003271826
Name:KLINKER THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:KLINKER THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:KLINKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:260-403-4788
Mailing Address - Street 1:12301 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46773-9586
Mailing Address - Country:US
Mailing Address - Phone:260-403-4788
Mailing Address - Fax:
Practice Address - Street 1:12301 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:IN
Practice Address - Zip Code:46773-9586
Practice Address - Country:US
Practice Address - Phone:260-403-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000223A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility