Provider Demographics
NPI:1639316086
Name:PEJUS, INC
Entity Type:Organization
Organization Name:PEJUS, INC
Other - Org Name:YOUR FRIENDS & NEIGHBORS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:JD
Authorized Official - Phone:260-459-1551
Mailing Address - Street 1:1515 MAGNAVOX WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1533
Mailing Address - Country:US
Mailing Address - Phone:260-459-1551
Mailing Address - Fax:260-459-1451
Practice Address - Street 1:1515 MAGNAVOX WAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1533
Practice Address - Country:US
Practice Address - Phone:260-459-1551
Practice Address - Fax:260-459-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)