Provider Demographics
NPI:1447310198
Name:SAMLIND OF INDIANA, INC.
Entity type:Organization
Organization Name:SAMLIND OF INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:TETTEH
Authorized Official - Last Name:QUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-695-3947
Mailing Address - Street 1:115 E. MICHIGAN STREET
Mailing Address - Street 2:P. O. BOX 568
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552
Mailing Address - Country:US
Mailing Address - Phone:574-654-8700
Mailing Address - Fax:574-654-8300
Practice Address - Street 1:115 E. MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552
Practice Address - Country:US
Practice Address - Phone:574-654-8700
Practice Address - Fax:574-654-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities