Healthcare Provider Details

I. General information

NPI: 1093573461
Provider Name (Legal Business Name): HELP CHANGING LIVES FOR THE BETTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 N FENTON AVE
INDIANAPOLIS IN
46219-5403
US

IV. Provider business mailing address

4164 N BUTLER AVE
INDIANAPOLIS IN
46226-4628
US

V. Phone/Fax

Practice location:
  • Phone: 317-457-1163
  • Fax: 317-941-7377
Mailing address:
  • Phone: 317-457-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JASMINE SANDERS
Title or Position: CEO
Credential:
Phone: 317-457-1163