MEDICARE: WELLPATH COMMUNITY CARE CENTERS OF INDIANA PC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1992469365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLPATH COMMUNITY CARE CENTERS OF INDIANA PC

Provider Business Mailing Address
First Line	:	1283 MURFREESBORO PIKE STE 500
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2421
Country	:	US
Telephone Number	:	615-258-8631
Fax Number	:

Provider Business Practice Location Address
First Line	:	5071 E 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2863
Country	:	US
Telephone Number	:	615-258-8631
Fax Number	:

Authorized Official
Title or Position	:	PC OWNER
Name	:	DR. STEVEN DESCOTEAUX
Credential	:	MD
Telephone Number	:	508-246-2202

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	01/28/2022

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