Healthcare Provider Details

I. General information

NPI: 1811811946
Provider Name (Legal Business Name): JAILN DASHAWN HOLMES SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S EMERSON AVE
INDIANAPOLIS IN
46237-1971
US

IV. Provider business mailing address

2808 S STATE AVE
INDIANAPOLIS IN
46203-5342
US

V. Phone/Fax

Practice location:
  • Phone: 317-661-1060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: