Provider Demographics
NPI:1356370449
Name:MICHIANA RESOURCES, INC.
Entity type:Organization
Organization Name:MICHIANA RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-874-4288
Mailing Address - Street 1:4315 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3151
Mailing Address - Country:US
Mailing Address - Phone:219-874-4288
Mailing Address - Fax:219-874-2689
Practice Address - Street 1:4315 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3151
Practice Address - Country:US
Practice Address - Phone:219-874-4288
Practice Address - Fax:219-874-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services