Healthcare Provider Details

I. General information

NPI: 1780503409
Provider Name (Legal Business Name): LIMELIGHT RECOVERY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 E 82ND ST
INDIANAPOLIS IN
46250-4510
US

IV. Provider business mailing address

5325 E 82ND ST PMB#172
INDIANAPOLIS IN
46250-4510
US

V. Phone/Fax

Practice location:
  • Phone: 812-994-0902
  • Fax:
Mailing address:
  • Phone: 812-994-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE FIANKO
Title or Position: OWNER
Credential:
Phone: 812-994-0902