Provider Demographics
NPI:1245974344
Name:LAUNCHPAD FOUNDATION, INC.
Entity type:Organization
Organization Name:LAUNCHPAD FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:260-424-0411
Mailing Address - Street 1:2200 LAKE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5351
Mailing Address - Country:US
Mailing Address - Phone:260-424-0411
Mailing Address - Fax:260-424-3530
Practice Address - Street 1:2200 LAKE AVE STE 260
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5351
Practice Address - Country:US
Practice Address - Phone:260-424-0411
Practice Address - Fax:260-424-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty