Provider Demographics
NPI:1962557579
Name:AIDS TASK FORCE OF LAPORTE AND PORTER COUNTIES
Entity type:Organization
Organization Name:AIDS TASK FORCE OF LAPORTE AND PORTER COUNTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-985-6170
Mailing Address - Street 1:5490 BROADWAY
Mailing Address - Street 2:L3
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1675
Mailing Address - Country:US
Mailing Address - Phone:219-985-6170
Mailing Address - Fax:219-985-6097
Practice Address - Street 1:5490 BROADWAY
Practice Address - Street 2:L3
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1675
Practice Address - Country:US
Practice Address - Phone:219-985-6170
Practice Address - Fax:219-985-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200109600Medicaid