CROSSROAD - FORT WAYNE CHILDRENS HOME (NPI# 1275614109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275614109 |
| Entity Type | Organization |
| Organization Name | CROSSROAD - FORT WAYNE CHILDRENS HOME |
| Practice Address |
2525 Lake Ave Fort Wayne IN 46805-5407 |
| Practice Telephone | 2604844153 |
| Mailing Telephone | 2604844153 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JC DOLLAR (CEO/PRESIDENT) |
| Authorized Official Telephone | 2604844153 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
7342602900837 | IN | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699868893 | Crossroad - Fort Wayne Childrens Home | Residential Treatment Facility, Emotionally Disturbed Children | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2006-10-02 |
| Street Address |
2525 LAKE AVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699868893 | Crossroad - Fort Wayne Childrens Home | Residential Treatment Facility, Emotionally Disturbed Children | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2006-10-02 |
| 1215491519 | Jeff Newman | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2019-01-31 |
| 1861956161 | Patricia Carol Ward | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2019-01-31 |
| 1063996551 | Sarah Noreen York | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-09-20 |
| 1841774346 | Candis Lea Luchnenko | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-09-20 |
| 1093299976 | Alan Dale Shupe | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-09-18 |
| 1962985424 | Matthew Brooks Flinn | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-09-11 |
| 1962984260 | Jon Robert Moseby | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-09-04 |
| 1497236442 | Katrina Louise Imber | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-08-28 |
| 1487135869 | Jackie Dean Vannatta Jr. | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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| 1447871116 | Loving Shepherd International Services & Foundation, Inc. | Clinic/Center | 1935 N Main St, Bluffton, IN 46714-1182 | 2020-05-04 |
| 1235773664 | Life Mentoring Inc. | Clinic/Center | 123 Harrington Ave Apt 2b, Crown Point, IN 46307-3843 | 2019-10-29 |
| 1265081301 | The Trauma and Addiction Treatment Center LLC | Clinic/Center | 1832 Explorer Ct, Franklin, IN 46131-6982 | 2019-09-11 |
| 1083275465 | The Academic Achievement Center, LLC | Clinic/Center | 2050 Doctors Park Dr, Columbus, IN 47203-2221 | 2019-06-26 |
| 1598263469 | Compass Counseling and Consulting Services, LLC. | Clinic/Center | 14074 Trade Center Dr Ste 247, Fishers, IN 46038-4579 | 2018-01-25 |
| 1366808834 | Change Therapy Center, LLC | Clinic/Center | 954 Eastport Centre Dr, Suite B, Valparaiso, IN 46383-4457 | 2016-01-13 |
| 1811234099 | Encouragement, LLC | Clinic/Center | 1017 Bontrager Ave, Elkhart, IN 46517-2811 | 2013-01-08 |
| 1861531386 | Zionsville Presbyterian Church | Clinic/Center | 4715 W 116th Street, Zionsville, IN 46077 | 2007-02-05 |
| 1003849605 | Ace Foster Care and Pediatric Home Nursing Agency | Clinic/Center | 7026 Indianapolis Blvd, Hammond, IN 46324-2208 | 2006-07-08 |
| 1730793530 | Choice Therapy | Clinic/Center | 12995 Star Dr, Fishers, IN 46037-5982 | 2020-08-31 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on CROSSROAD - FORT WAYNE CHILDRENS HOME.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.