Healthcare Provider Details

I. General information

NPI: 1013060714
Provider Name (Legal Business Name): EAST INDIANA TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 RUDOLPH WAY
GREENDALE IN
47025-8312
US

IV. Provider business mailing address

PO BOX 682669
FRANKLIN TN
37068-2669
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-1668
  • Fax: 812-537-1625
Mailing address:
  • Phone: 760-710-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10780ASR
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number10780ASR
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number10780ASR
License Number StateIN

VIII. Authorized Official

Name: BRIAN FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000