Provider Demographics
NPI:1710232574
Name:THE ARC NORTHWEST INDIANA
Entity Type:Organization
Organization Name:THE ARC NORTHWEST INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PROHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-884-1138
Mailing Address - Street 1:440 N KNOX ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2093
Mailing Address - Country:US
Mailing Address - Phone:219-884-1138
Mailing Address - Fax:219-980-7315
Practice Address - Street 1:2650 W 35TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-1416
Practice Address - Country:US
Practice Address - Phone:219-884-1138
Practice Address - Fax:219-980-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities