Healthcare Provider Details

I. General information

NPI: 1679286272
Provider Name (Legal Business Name): NULIFE INDIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9623 WINDERMERE BLVD
FISHERS IN
46037-9180
US

IV. Provider business mailing address

1451 ROUTE 88 STE 5
BRICK NJ
08724-2371
US

V. Phone/Fax

Practice location:
  • Phone: 806-230-1770
  • Fax:
Mailing address:
  • Phone: 845-372-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX ZIEGER
Title or Position: OWNER
Credential:
Phone: 845-372-6480