Provider Demographics
NPI:1922066679
Name:MENNONITE DISABILITIES COMMITTEE, INC.
Entity Type:Organization
Organization Name:MENNONITE DISABILITIES COMMITTEE, INC.
Other - Org Name:MDC GOLDENROD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUSINKVELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-533-9720
Mailing Address - Street 1:1518 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6527
Mailing Address - Country:US
Mailing Address - Phone:574-533-9720
Mailing Address - Fax:574-534-9817
Practice Address - Street 1:1518 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6527
Practice Address - Country:US
Practice Address - Phone:574-533-9720
Practice Address - Fax:574-534-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care