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EASTER SEALS REHABILITATION CENTER INC. NPI 1003979964


NPI Information

NPI: 1003979964
Provider Name: EASTER SEALS REHABILITATION CENTER, INC.
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

CLIA Number: 15D0716243

Address:
3701 BELLEMEADE AVE
EVANSVILLE, IN
ZIP 47714
Phone: (812) 479-1411
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EASTER SEALS REHABILITATION CENTER, INC. is an adolescent and children mental health clinic center in Evansville, IN. The provider is 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. EASTER SEALS REHABILITATION CENTER, INC. NPI is 1003979964. The provider is registered as an organization entity type.

The provider's business location address is:

3701 BELLEMEADE AVE
EVANSVILLE, IN
ZIP 47714-137
Phone: (812) 479-1411
Fax: (812) 437-2636

The provider's authorized official is Rea Tecson .
The authorized official title is Cfo and has the following contact phone number (812) 479-1411.

The CLIA number assigned to this NPI record is 15D0716243 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/19/2006 and was last updated on 1/23/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QD1600XClinic/CenterDevelopmental DisabilitiesNo
2261QM0850XClinic/CenterAdult Mental HealthNo
3261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200263500AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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