MEDICARE: NEW HOPE OF INDIANA, INC.

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	310500000X	Mental Illness Intermediate Care Facility	31050000	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861431520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HOPE OF INDIANA, INC.

Provider Business Mailing Address
First Line	:	8450 N PAYNE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6621
Country	:	US
Telephone Number	:	317-338-9600
Fax Number	:	317-338-4585

Provider Business Practice Location Address
First Line	:	4822 ALAMEDA RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2009
Country	:	US
Telephone Number	:	317-338-9600
Fax Number	:	317-338-4585

Authorized Official
Title or Position	:	CEO
Name	:	JAMES C. VAN DYKE
Credential	:
Telephone Number	:	317-338-4501

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/08/2014

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