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5555 N Tacoma Ave Indianapolis IN 46220-3512 | |
| (317) 523-8963 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5555 N Tacoma Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Robin Jerene Eutz (CEO/FOUNDER) |
| Authorized Official Contact | 3175238963 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5555 N Tacoma Ave Indianapolis IN 46220-3512 Ph: (317) 523-8963 | 5555 N Tacoma Ave Indianapolis IN 46220-3512 Ph: (317) 523-8963 |
| NPI Number | 1740728930 |
|---|---|
| Provider Enumeration Date | 02/07/2017 |
| Last Update Date | 03/03/2022 |
| Certification Date | 03/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740728930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 87000274A (Indiana) | Primary |
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