Healthcare Provider Details

I. General information

NPI: 1275255481
Provider Name (Legal Business Name): URBAN FAMILY INITIATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GEORGETOWN ROAD SUITE D
INDIANAPOLIS IN
46254-3717
US

IV. Provider business mailing address

3510 WATERSTONE COURT
INDIANAPOLIS IN
46268-4845
US

V. Phone/Fax

Practice location:
  • Phone: 317-373-3730
  • Fax:
Mailing address:
  • Phone: 317-373-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES W. DIX III
Title or Position: FOUNDER/CEO
Credential: PH.D.
Phone: 317-373-3730