JAY-RANDOLPH DEVELOPMENTAL SERVICES INC. NPI 1831143478

NPI Information

NPI: 1831143478
Provider Name: JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
CLIA Number: 15D0997488
Address: 901 E WATER ST
PORTLAND, IN
ZIP 47371
Phone: (260) 726-7931

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NPI Details

JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC. is an intermediate care facility mentally retarded in Portland, IN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. JAY-RANDOLPH DEVELOPMENTAL SERVICES, INC. NPI is 1831143478. The provider is registered as an organization entity type.

The provider's business location address is:

901 E WATER ST
PORTLAND, IN
ZIP 47371-038
Phone: (260) 726-7931
Fax: (260) 726-8184

The provider's authorized official is Anita Young .
The authorized official title is Executive Director and has the following contact phone number (260) 726-7931.

The CLIA number assigned to this NPI record is 15D0997488 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/19/2006 and was last updated on 8/22/2020.

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 Code	Taxonomy Clasification	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities	2623I0004JN07	INDIANA	No
2	315P00000X	Intermediate Care Facility, Intellectual Disabilities	2623B0006JN06	INDIANA	No
3	315P00000X	Intermediate Care Facility, Intellectual Disabilities	2623T0003JN07	INDIANA	No
4	315P00000X	Intermediate Care Facility, Intellectual Disabilities	2623I0005JN06	INDIANA	Yes

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: 11/21/2025

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