CROSSROAD - FORT WAYNE CHILDRENS HOME (NPI# 1699868893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699868893 |
| 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 | 2006-10-02 |
| 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 |
|---|---|---|---|---|---|
| X | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 3001702900002 | IN | Residential Treatment Facilities |
| X | 323P00000X | Psychiatric Residential Treatment Facility | 3001702900002 | IN | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275614109 | Crossroad - Fort Wayne Childrens Home | Clinic/Center | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2006-10-18 |
| Street Address |
2525 LAKE AVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1770064214 | Natalie M Cook | Case Manager/Care Coordinator | 2525 Lake Ave, Fort Wayne, IN 46805-5407 | 2018-08-23 |
| 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 | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417227984 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 2301 Jefferson St, Gary, IN 46407-3043 | 2011-12-30 |
| 1811206493 | Shults-lewis Child and Family Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 325 South 150 East, Valparaiso, IN 46383-7866 | 2010-09-30 |
| 1336454552 | Wernle Youth & Family Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 2000 Wernle Rd, Richmond, IN 47374-7015 | 2010-08-12 |
| 1730494360 | Resource Community Based Services Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1404 S State Ave, Indianapolis, IN 46203-2009 | 2010-08-06 |
| 1356671192 | Sequel Tsi of Indiana, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2426 S Parker Ln, Lexington, IN 47138-8561 | 2009-12-29 |
| 1578897773 | Open Arms Christian Ministries, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4516 W State Road 54, Bloomfield, IN 47424-5207 | 2009-09-22 |
| 1871749119 | Gibault, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 6301 S Us Highway 41, Terre Haute, IN 47802-4771 | 2008-08-18 |
| 1528285897 | St. Joseph Home for Boys, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4007 S Sheffield Ave, Hammond, IN 46327-1242 | 2007-04-19 |
| 1144353715 | Willowglen Academy - Indiana | Residential Treatment Facility, Emotionally Disturbed Children | 308 E 21st Ave, Gary, IN 46407-2618 | 2007-03-13 |
| 1861587230 | Success Acq Corp | Residential Treatment Facility, Emotionally Disturbed Children | 3455 West Vermont, Indianapolis, IN 46222 | 2006-10-03 |
| 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.