Provider Demographics
NPI:1093875775
Name:SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF INDIANA, INC.
Entity Type:Organization
Organization Name:SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF INDIANA, INC.
Other - Org Name:SAFY OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:260-443-6191
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9058
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:70 E 91ST ST STE 109
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1550
Practice Address - Country:US
Practice Address - Phone:317-218-4081
Practice Address - Fax:317-218-4086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200013900Medicare ID - Type UnspecifiedRENDERING