Provider Demographics
NPI:1811206493
Name:SHULTS-LEWIS CHILD AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:SHULTS-LEWIS CHILD AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:219-462-0513
Mailing Address - Street 1:P.O. BOX 471
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-0471
Mailing Address - Country:US
Mailing Address - Phone:219-462-0513
Mailing Address - Fax:219-464-7828
Practice Address - Street 1:325 SOUTH 150 EAST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7866
Practice Address - Country:US
Practice Address - Phone:219-462-0513
Practice Address - Fax:219-464-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16206793332195322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children