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PARK CENTER, INC.
NPI 1053594663
Community/Behavioral Health in Fort Wayne, IN

Active since December 06, 2007CLIA 15D2156782 · Waiver
909 E STATE BLVD, FORT WAYNE, IN 46805(260) 481-2700(260) 481-2717 Get Directions Write a Review

NPPES record last updated: October 31, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Park Center, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK CENTER, INC. (NPI 1053594663) is a healthcare organization registered as a community/behavioral health in Fort Wayne, Indiana and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through October 23, 2026 and lists Stanton Risser, Acfo, as its authorized official.

NPPES Registry Identity

NPI1053594663
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NamePARK CENTER, INC.
Location Address909 E STATE BLVDFort Wayne, IN 46805-3404
Mailing Address909 E State BlvdFort Wayne, IN 46805-3404 · (260) 481-2700 · Fax (260) 481-2717
Phone(260) 481-2700
Fax(260) 481-2717
Organization SubpartNo
Authorized OfficialStanton RisserAcfo · (260) 266-9380
Enumeration DateDecember 6, 2007
Last NPPES UpdateOctober 31, 2024
NPPES CertifiedOctober 31, 2024
✔ NPI 1053594663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
909 E STATE BLVD, Fort Wayne, IN 46805
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Other Identifiers 2

Medicaid100463190AIN
Medicaid100463190BIN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2156782

Park Center Walk-In Clinic · Fort Wayne, IN
Active · expires Oct 23, 2026
CLIA Number15D2156782
Laboratory TypePhysician Office
Certificate Effective DateOctober 24, 2024
Certificate Expiration DateOctober 23, 2026
Laboratory DirectorAhsan Mahmood
Laboratory Phone(260) 471-9440
Laboratory LocationPark Center Walk-In Clinic2710 Lake Ave, Fort Wayne, IN 46805
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COURTNEY LESLEY WASHINGTON
Counselor
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
JENNIFER PERRY MS
Counselor (Mental Health)
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
MICHELLE ELISE WIESE MD
Psychiatry & Neurology (Psychiatry)
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
SARAH MICHELLE MOORE APRN-CNM, PMHNP-BC
Nurse Practitioner
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
JULIE NAY WINN BS
Case Manager/Care Coordinator
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
TONYA J EIDEN LMHC, MS
Counselor (Mental Health)
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
ANGELA C DESPENZA LPN
Licensed Practical Nurse
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700
MEGAN I FIGUEROA RN
Registered Nurse
909 E STATE BLVD
FORT WAYNE, IN 46805
Allen County (260) 481-2700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park Center, Inc.'s NPI number?

The NPI number for Park Center, Inc. is 1053594663. It was assigned to this organization in the NPPES registry on December 6, 2007.

Where is Park Center, Inc. located?

Park Center, Inc. is located at 909 E State Blvd, Fort Wayne, IN 46805. The listed phone number is (260) 481-2700.

What is Park Center, Inc.'s specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Does Park Center, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2156782) is associated with this NPI, valid through October 23, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Park Center, Inc. was last updated on October 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.