Provider Demographics
NPI:1902042484
Name:INTERBEING, LLC
Entity Type:Organization
Organization Name:INTERBEING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-232-1405
Mailing Address - Street 1:211 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1910
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1711
Mailing Address - Country:US
Mailing Address - Phone:574-232-1405
Mailing Address - Fax:574-232-0124
Practice Address - Street 1:211 W WASHINGTON ST
Practice Address - Street 2:SUITE 1910
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1711
Practice Address - Country:US
Practice Address - Phone:574-232-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002568A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200924700 AMedicaid
259460Medicare PIN