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NPI 1649967381 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · West Lafayette, IN
Provider details
- NPI number
- 1649967381
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Jasmine Henry, Ceo(708) 821-9642
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Agencies
- Community/Behavioral Health Agency251S00000X
Agencies
Respite Care Facility
Practice location
3623 N 250 W
West Lafayette, IN 47906-5504
Phone: (708) 821-9642
Approximate (ZIP-level) locationGet directions
Mailing address
3623 N 250 W
West Lafayette, IN 47906-5504
Registry dates
- Enumerated
- 2023-04-21
- Last updated
- 2023-04-21
- Certified
- 2023-04-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.