Provider Demographics
NPI:1598847212
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:
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 1:2600 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-1533
Practice Address - Country:US
Practice Address - Phone:574-533-1234
Practice Address - Fax:574-537-2652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAWN PSYCHIATRIC CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN409-0-CMHC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097755OtherBLUE CROSS
INCB2281OtherRAILROAD MEDICARE
IN100111390Medicaid
INDB1691OtherRAILROAD MEDICARE
IN351OtherCHAMPUS
IN184400Medicare ID - Type UnspecifiedHSPPS
INCB2281OtherRAILROAD MEDICARE
IN000000097755OtherBLUE CROSS