Healthcare Provider Details

I. General information

NPI: 1558322776
Provider Name (Legal Business Name): VILLAGES OF INDIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N SMITH PIKE
BLOOMINGTON IN
47404-1363
US

IV. Provider business mailing address

2405 N SMITH PIKE
BLOOMINGTON IN
47404-1363
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-1245
  • Fax: 812-333-4717
Mailing address:
  • Phone: 812-332-1245
  • Fax: 812-333-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY J DAVIS
Title or Position: COMPLIANCE MGR
Credential:
Phone: 812-332-1245