1235774365 NPI number — AWARE RECOVERY CARE OF INDIANA, LLC

Table of content: (NPI 1235774365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235774365 NPI number — AWARE RECOVERY CARE OF INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AWARE RECOVERY CARE OF INDIANA, LLC
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:
PARENT: AWARE RECOVERY CARE, INC.
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:
1235774365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 THORPE AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492-1948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-779-5799
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6505 E. 82ND STREET
Provider Second Line Business Practice Location Address:
#120
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-779-0310
Provider Business Practice Location Address Fax Number:
203-421-6830
Provider Enumeration Date:
11/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ASHCROFT
Authorized Official First Name:
RICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PAYER RELATIONS
Authorized Official Telephone Number:
203-640-0091

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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