Provider Demographics
NPI:1043423312
Name:PIKE COUNTY AREA REHABILITATION CENTERS INC
Entity Type:Organization
Organization Name:PIKE COUNTY AREA REHABILITATION CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COCKRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-386-6312
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-0005
Mailing Address - Country:US
Mailing Address - Phone:812-386-6312
Mailing Address - Fax:812-385-8778
Practice Address - Street 1:1214 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-1339
Practice Address - Country:US
Practice Address - Phone:812-354-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
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