Healthcare Provider Details

I. General information

NPI: 1811537319
Provider Name (Legal Business Name): LANDMARK OUTPATIENT SERVICES OF CARMEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13594 N MERIDIAN ST
CARMEL IN
46032-1698
US

IV. Provider business mailing address

4835 E CACTUS RD STE 130
SCOTTSDALE AZ
85254-3545
US

V. Phone/Fax

Practice location:
  • Phone: 888-448-0302
  • Fax:
Mailing address:
  • Phone: 888-448-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE ZIMMERMAN
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 480-296-8619