MEDICARE: LIFE RECOVERY ASSOCIATES, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235381864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE RECOVERY ASSOCIATES, LLC.

Provider Business Mailing Address
First Line	:	8110 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-887-3290
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-887-3290
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIC L. DAVIS
Credential	:	LCSW
Telephone Number	:	317-887-3290

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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