Provider Demographics
NPI:1861851685
Name:ELKHART COUNTY CLUBHOUSE
Entity type:Organization
Organization Name:ELKHART COUNTY CLUBHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-202-3920
Mailing Address - Street 1:114 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-3712
Mailing Address - Country:US
Mailing Address - Phone:574-971-5210
Mailing Address - Fax:574-971-5211
Practice Address - Street 1:114 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-3712
Practice Address - Country:US
Practice Address - Phone:574-971-5210
Practice Address - Fax:574-971-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health