Provider Demographics
NPI:1720817109
Name:RYAN'S PLACE INC
Entity type:Organization
Organization Name:RYAN'S PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIENER-LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:574-535-1000
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46527-0073
Mailing Address - Country:US
Mailing Address - Phone:574-535-1000
Mailing Address - Fax:
Practice Address - Street 1:118 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3702
Practice Address - Country:US
Practice Address - Phone:574-535-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)