Provider Demographics
NPI:1851196455
Name:STABLE GAINS MENTAL HEALTH SERVICE LLC
Entity type:Organization
Organization Name:STABLE GAINS MENTAL HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:574-701-2355
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-0404
Mailing Address - Country:US
Mailing Address - Phone:574-701-2355
Mailing Address - Fax:
Practice Address - Street 1:304 N WALNUT ST RM 9
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1787
Practice Address - Country:US
Practice Address - Phone:574-701-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health