Provider Demographics
NPI:1619144946
Name:PARENTS COUNCIL FOR CHILDREN WITH SPECIAL NEEDS OF LAPORTE COUNTY, INC
Entity Type:Organization
Organization Name:PARENTS COUNCIL FOR CHILDREN WITH SPECIAL NEEDS OF LAPORTE COUNTY, INC
Other - Org Name:BARKER WOODS ENRICHMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JO ANNE
Authorized Official - Last Name:RODECAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-872-6996
Mailing Address - Street 1:3200 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7027
Mailing Address - Country:US
Mailing Address - Phone:219-872-6996
Mailing Address - Fax:219-872-7828
Practice Address - Street 1:3200 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7027
Practice Address - Country:US
Practice Address - Phone:219-872-6996
Practice Address - Fax:219-872-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200861250AMedicaid