MEDICARE: ADDICTION REHAB CENTERS AT INDIANAPOLIS

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1518748391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION REHAB CENTERS AT INDIANAPOLIS

Provider Business Mailing Address
First Line	:	486 MATTHEWS LN
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-4401
Country	:	US
Telephone Number	:	718-288-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	7322 NOEL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1515
Country	:	US
Telephone Number	:	844-551-4673
Fax Number	:

Authorized Official
Title or Position	:	OPERATOR
Name	:	SHEA FRIEDMAN
Credential	:
Telephone Number	:	718-288-1160

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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