Provider Demographics
NPI:1689627598
Name:PORTER-STARKE SERVICES INC.
Entity Type:Organization
Organization Name:PORTER-STARKE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:IDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:219-531-3500
Mailing Address - Street 1:601 WALL ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2512
Mailing Address - Country:US
Mailing Address - Phone:219-531-3500
Mailing Address - Fax:219-462-3975
Practice Address - Street 1:2507 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2503
Practice Address - Country:US
Practice Address - Phone:219-476-4676
Practice Address - Fax:219-462-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN418-0-CMHC261QM0801X
IN418-0-ASR261QM0801X
IN418-14-9-14261QM0801X
IN418-0-GAM261QM0801X
IN418-0-SMI261QM0801X
IN61100664B261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100207670AMedicaid
INCB7125OtherMEDICARE RAILROAD
IN000000112682OtherANTHEM
IN000000112682OtherANTHEM
657050Medicare PIN
IN651990Medicare PIN
INW39549Medicare UPIN