Provider Demographics
NPI:1427257328
Name:WERNLE CHILDREN'S HOME, INC
Entity type:Organization
Organization Name:WERNLE CHILDREN'S HOME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-939-4520
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-1386
Mailing Address - Country:US
Mailing Address - Phone:765-966-2506
Mailing Address - Fax:765-962-4210
Practice Address - Street 1:2000 WERNLE ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7014
Practice Address - Country:US
Practice Address - Phone:765-966-2506
Practice Address - Fax:765-962-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200386270Medicaid
IN200386270AMedicaid