MEDICARE: AGENCY FOR PRECISION LIVING AND LEARNING 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	251C00000X	Developmentally Disabled Services Day Training Agency	1119344	IN

General Provider Information

NPI Number	:	1952792749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENCY FOR PRECISION LIVING AND LEARNING LLC

Provider Business Mailing Address
First Line	:	5523 GLEN CANYON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-4412
Country	:	US
Telephone Number	:	317-519-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	5523 GLEN CANYON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-4412
Country	:	US
Telephone Number	:	317-519-6692
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DEBRAH WORLAND
Credential	:	BCBA
Telephone Number	:	317-519-6692

Provider Enumeration Date	:	02/14/2015
Last Update Date	:	02/14/2015

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