Provider Demographics
NPI:1821294265
Name:THE SAMARITAN CENTERS OF NORTHEAST INDIANA, INC
Entity Type:Organization
Organization Name:THE SAMARITAN CENTERS OF NORTHEAST INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR OF ADMIN AND CLIENT SEREVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LITZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-657-5682
Mailing Address - Street 1:300 W WAYNE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3608
Mailing Address - Country:US
Mailing Address - Phone:260-422-8556
Mailing Address - Fax:260-422-8558
Practice Address - Street 1:300 W WAYNE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3608
Practice Address - Country:US
Practice Address - Phone:260-422-8556
Practice Address - Fax:260-422-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty