Provider Demographics
NPI:1396082863
Name:PADDOCK VIEW RESIDENTIAL CENTER, INC.
Entity type:Organization
Organization Name:PADDOCK VIEW RESIDENTIAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:765-664-7740
Mailing Address - Street 1:1700 E BRADFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-8643
Mailing Address - Country:US
Mailing Address - Phone:765-664-7740
Mailing Address - Fax:765-664-7743
Practice Address - Street 1:1700 E BRADFORD PIKE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-8643
Practice Address - Country:US
Practice Address - Phone:765-664-7740
Practice Address - Fax:765-664-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041950A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health