1225251275 NPI number — INDIANA UNIVERSITY - AREA 9 IN-HOME AND COMMUNITY SERVICES AGENCY

Table of content: (NPI 1225251275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225251275 NPI number — INDIANA UNIVERSITY - AREA 9 IN-HOME AND COMMUNITY SERVICES AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY - AREA 9 IN-HOME AND COMMUNITY SERVICES AGENCY
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:
INDIANA UNIVERSITY
Provider Other Organization Name Type Code:
5
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:
1225251275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374-6230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-966-1795
Provider Business Mailing Address Fax Number:
765-966-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374-6230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-966-1795
Provider Business Practice Location Address Fax Number:
765-966-1190
Provider Enumeration Date:
04/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ASSISTANT VICE PRESIDENT RESEARCH
Authorized Official Telephone Number:
812-855-3963

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200348890 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".