Residential Crf, INC.
Intermediate Care Facility, Intellectual Disabilities in Modoc, IN. Organization (NPI-2).
NPI number1104967751
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1104967751
- Entity type
- Organization (NPI-2)
- Legal business name
- Residential Crf, INC.
- Organization subpart
- No
- Enumeration date
- Feb 8, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | – | – | Yes |
Practice location
8500 W Us Highway 36Modoc, IN 47358-9495
Phone 765-853-5009
Mailing address
1117 N Central AveConnersville, IN 47331-2126
Phone 765-825-5129 · Fax 765-825-0074
Authorized official
Raymond A Mauger
President
7658255129
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