| Lifeline Youth & Family Services, Inc. | |
|
27 Pequignot Drive Pierceton IN 46562-9075 | |
| (260) 745-3322 | |
| Not Available |
| Full Name | Lifeline Youth & Family Services, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 27 Pequignot Drive, Pierceton, Indiana |
| Authorized Official Name and Position | Michael J. Martin (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2607453322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeline Youth & Family Services, Inc. Po Box 80487 Fort Wayne IN 46898-0487 Ph: (260) 745-3322 | Lifeline Youth & Family Services, Inc. 27 Pequignot Drive Pierceton IN 46562-9075 Ph: (260) 745-3322 |
| NPI Number | 1952590911 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 04/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952590911 | NPI | - | NPPES |
| 200847310 | Medicaid | IN | |
| 200847300 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 347C00000X | Private Vehicle | (* (Not Available)) | Secondary |
Pwa & Spencer Home Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 27 Pequignot Dr, Pierceton, IN 46562 Phone: 260-702-3752 Fax: 866-681-7794 |