Provider Demographics
NPI:1063616340
Name:POSSIBILITIES NORTHEAST, LLC
Entity type:Organization
Organization Name:POSSIBILITIES NORTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-338-1241
Mailing Address - Street 1:808 MILL LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-6400
Mailing Address - Country:US
Mailing Address - Phone:260-338-1241
Mailing Address - Fax:260-338-1231
Practice Address - Street 1:808 MILL LAKE ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-6400
Practice Address - Country:US
Practice Address - Phone:260-338-1241
Practice Address - Fax:260-338-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty