Provider Demographics
NPI:1184068264
Name:TIMILLA'S MENTORING CENTER
Entity type:Organization
Organization Name:TIMILLA'S MENTORING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIMILLA
Authorized Official - Middle Name:AIMILE
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-628-3721
Mailing Address - Street 1:1601 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-2239
Mailing Address - Country:US
Mailing Address - Phone:219-628-3721
Mailing Address - Fax:219-882-0210
Practice Address - Street 1:1601 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-2239
Practice Address - Country:US
Practice Address - Phone:219-628-3721
Practice Address - Fax:219-882-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health