Provider Demographics
NPI:1780778266
Name:TRADEWINDS SERVICES, INC.
Entity type:Organization
Organization Name:TRADEWINDS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-945-0100
Mailing Address - Street 1:3198 E 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6418
Mailing Address - Country:US
Mailing Address - Phone:219-945-0100
Mailing Address - Fax:219-940-3369
Practice Address - Street 1:3198 E 83RD PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6418
Practice Address - Country:US
Practice Address - Phone:219-945-0100
Practice Address - Fax:219-940-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000137A225X00000X
IN22003978A235Z00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200714400Medicaid
IN100243200Medicaid
IN100248690Medicaid
IN100249270Medicaid
IN100229500Medicaid
IN100243530Medicaid
IN200059730Medicaid