Provider Demographics
NPI:1467407395
Name:OAKLAWN PSYCHIATRIC CENTER, INC.
Entity Type:Organization
Organization Name:OAKLAWN PSYCHIATRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. - FINANCE, C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-533-1234
Mailing Address - Street 1:330 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-9365
Mailing Address - Country:US
Mailing Address - Phone:574-533-1234
Mailing Address - Fax:574-537-2652
Practice Address - Street 1:330 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-9365
Practice Address - Country:US
Practice Address - Phone:574-533-1234
Practice Address - Fax:574-537-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN409-4-PIP283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000097755OtherBLUE CROSS
351OtherCHAMPUS
CB2281OtherRAILROAD MEDICARE GROUP
DB1691OtherRAILROAD MEDICARE GROUP
DB1691OtherRAILROAD MEDICARE GROUP
000000097755OtherBLUE CROSS