Provider Demographics
NPI:1205452588
Name:PATHFINDERS CHILD AND FAMILY SERVICES LLC
Entity type:Organization
Organization Name:PATHFINDERS CHILD AND FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:812-391-0358
Mailing Address - Street 1:10882 LANTERN VIEW DR APT 203
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4212
Mailing Address - Country:US
Mailing Address - Phone:812-391-0358
Mailing Address - Fax:
Practice Address - Street 1:10882 LANTERN VIEW DR APT 203
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4212
Practice Address - Country:US
Practice Address - Phone:812-391-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty