| 180 Enterprise | |
|
3430 Cork Bend Dr Indianapolis IN 46239-7669 | |
| (317) 966-7772 | |
| Not Available |
| Full Name | 180 Enterprise |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 3430 Cork Bend Dr, Indianapolis, Indiana |
| Authorized Official Name and Position | Kimtoiya Sam (OWNER) |
| Authorized Official Contact | 3179667772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 180 Enterprise 3430 Cork Bend Dr Indianapolis IN 46239-7669 Ph: (317) 966-7772 | 180 Enterprise 3430 Cork Bend Dr Indianapolis IN 46239-7669 Ph: (317) 966-7772 |
| NPI Number | 1619564549 |
|---|---|
| Provider Enumeration Date | 12/27/2020 |
| Last Update Date | 12/27/2020 |
| Certification Date | 12/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619564549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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