Provider Demographics
NPI:1669174132
Name:WABASH CENTER, INC.
Entity type:Organization
Organization Name:WABASH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-423-5531
Mailing Address - Street 1:1500 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2147
Mailing Address - Country:US
Mailing Address - Phone:765-423-5531
Mailing Address - Fax:
Practice Address - Street 1:1500 SALEM ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2147
Practice Address - Country:US
Practice Address - Phone:765-423-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WABASH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty