Provider Demographics
NPI:1821115569
Name:CHILDREN'S SANCTUARY, INC.
Entity Type:Organization
Organization Name:CHILDREN'S SANCTUARY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-485-0870
Mailing Address - Street 1:3711 RUPP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4523
Mailing Address - Country:US
Mailing Address - Phone:260-485-0870
Mailing Address - Fax:
Practice Address - Street 1:3711 RUPP DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4523
Practice Address - Country:US
Practice Address - Phone:260-485-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IN53527251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty