Healthcare Provider Details

I. General information

NPI: 1447093505
Provider Name (Legal Business Name): MADISON COUNTY PATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MERIDIAN ST
ANDERSON IN
46016-1518
US

IV. Provider business mailing address

601 MERIDIAN ST
ANDERSON IN
46016-1518
US

V. Phone/Fax

Practice location:
  • Phone: 765-810-7258
  • Fax:
Mailing address:
  • Phone: 765-810-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMRA RIGDON
Title or Position: CLINCIAL DIRECTOR
Credential: LSW/LAC
Phone: 765-810-7258