NPI 1043434624

Adec-Bridlewood

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Goshen, IN

Practice location

Address: 58808 St Marys Ln, Goshen, IN 46528-7623
Phone: (574) 848-7451
Fax: (574) 818-5917
Mailing address: 19670 Sr 120, Bristol, IN 46507-0398

Authorised official

Name: Paula M Shively
Title: Ceo
Phone: (574) 848-7451

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 2670I0017JN08 (IN)

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Registry record

NPI: 1043434624
Entity type: Organization
NPI issued: 12 Apr 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.