| Original Housing Program | |
|
3539 N College Ave # 1 Indianapolis IN 46205-3755 | |
| (317) 258-0302 | |
| Not Available |
| Full Name | Original Housing Program |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 3539 N College Ave # 1, Indianapolis, Indiana |
| Authorized Official Name and Position | Latoya Vinettie Beverly (NON CLINICAL) |
| Authorized Official Contact | 3175595802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Original Housing Program 3902 N College Ave Indianapolis IN 46205-2735 Ph: (317) 258-0302 | Original Housing Program 3539 N College Ave # 1 Indianapolis IN 46205-3755 Ph: (317) 258-0302 |
| NPI Number | 1659928794 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 08/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659928794 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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