Provider Demographics
NPI:1417019241
Name:THE ARC OF NORTHEAST INDIANA INC.
Entity Type:Organization
Organization Name:THE ARC OF NORTHEAST INDIANA INC.
Other - Org Name:EASTER SEALS ARC OF NORTHEAST INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-456-4534
Mailing Address - Street 1:4919 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5532
Mailing Address - Country:US
Mailing Address - Phone:260-456-4534
Mailing Address - Fax:260-745-5200
Practice Address - Street 1:2524 BEECHWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1201
Practice Address - Country:US
Practice Address - Phone:260-456-4534
Practice Address - Fax:260-745-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2602B0009JN05315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100243390Medicaid