Provider Demographics
NPI:1427286079
Name:PROVISIONS EDUCATIONAL NETWORK INC
Entity type:Organization
Organization Name:PROVISIONS EDUCATIONAL NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:219-980-6100
Mailing Address - Street 1:5201 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1595
Mailing Address - Country:US
Mailing Address - Phone:219-980-6100
Mailing Address - Fax:
Practice Address - Street 1:5201 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1595
Practice Address - Country:US
Practice Address - Phone:219-980-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health