LOGAN COMMUNITY RESOURCES, INC. (NPI# 1891917449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891917449 |
| Entity Type | Organization |
| Organization Name | LOGAN COMMUNITY RESOURCES, INC. |
| Practice Address |
2505 E. Jefferson Blvd South Bend IN 46615 |
| Practice Telephone | 5742894831 |
| Practice Fax Number | 5742342075 |
| Mailing Telephone | 5742894831 |
| Mailing Fax Number | 5742342075 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-08-01 |
| Authorized Official Name | MR. CLINT BOLSER (CEO) |
| Authorized Official Telephone | 5742894831 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 251C00000X | Day Training, Developmentally Disabled Services | Agencies | ||
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100108330 | 05 | |
| IN | 201036530 | 05 |
| Street Address |
2505 E. JEFFERSON BLVD |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679954804 | Healthlinc, Inc. | Clinic/Center | 1002 S Esther St, South Bend, IN 46615 | 2015-06-12 |
| 1861897688 | Michelle Jean Streb | Registered Nurse | 1960 Northside Boulevard, South Bend, IN 46615 | 2014-10-23 |
| 1275848962 | Charles Mikel Craig | Optometrist | 220 N. Ironwood Dr., South Bend, IN 46615 | 2010-08-18 |
| 1710219613 | Debra Vasquez | Occupational Therapy Assistant | 1950 Ridgedaleroad, South Bend, IN 46615 | 2010-02-03 |
| 1114259132 | Christopher Joseph Smith | Physical Therapist | 1005 Hickory Rd, South Bend, IN 46615 | 2010-02-01 |
| 1295064525 | Starlight Care Facilities, Inc | Skilled Nursing Facility | 915 So. 27th Street, South Bend, IN 46615 | 2009-12-16 |
| 1699002642 | Ann G Pryor | Contractor | 1516 E. Wayne St., South Bend, IN 46615 | 2009-11-12 |
| 1487712683 | Julie Gaydos Plagens | Dentist | 604 South Eddy St, South Bend, IN 46615 | 2006-12-04 |
| 1629163084 | Edward F Klodzinski | Counselor | 3603 E. Jefferson Blvd., South Bend, IN 46615 | 2006-10-03 |
| 1255448452 | John D Bond Dds Inc | Dentist | 915 S Ironwood, South Bend, IN 46615 | 2006-08-24 |
| Find all providers in zip 46615 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346691177 | Miami Homecare Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1912 Miami St, South Bend, IN 46613-2915 | 2016-06-22 |
| 1497965222 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 119 Spruce St, South Bend, IN 46616-1129 | 2007-05-23 |
| 1003026642 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2105 Wabash St, South Bend, IN 46613-1138 | 2007-05-23 |
| 1912117557 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3031 Bentley Ln, South Bend, IN 46615-3607 | 2007-05-23 |
| 1841400488 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1325 Brentwood Ct, South Bend, IN 46628-1326 | 2007-05-23 |
| 1316157126 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2804 Corpus Christi Dr, South Bend, IN 46628-3430 | 2007-05-23 |
| 1154531184 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 20089 Lark Dr, South Bend, IN 46637-3023 | 2007-05-22 |
| 1164632105 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1602 Orkney Dr, South Bend, IN 46614-3562 | 2007-05-22 |
| 1477763415 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1917 S Walnut St, South Bend, IN 46613-1541 | 2007-05-22 |
| 1265553606 | Corvilla Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18443 Bulla Rd, South Bend, IN 46637-5426 | 2007-04-03 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.