1124177340 NPI number — FAMILY SERVICEOF CENTRAL INDIANA, INC.

Table of content: (NPI 1124177340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124177340 NPI number — FAMILY SERVICEOF CENTRAL INDIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICEOF CENTRAL INDIANA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124177340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 NORTH ALABAMA STREET
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204-1481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-634-6341
Provider Business Mailing Address Fax Number:
317-464-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46151-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-342-0202
Provider Business Practice Location Address Fax Number:
765-342-2761
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
EDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-634-6341

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100264520 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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