Healthcare Provider Details

I. General information

NPI: 1215669122
Provider Name (Legal Business Name): MISSION HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11405 LONG LAKE DRIVE
INDIANAPOLIS IN
46235
US

IV. Provider business mailing address

5868 E 71ST STREET SUITE E #667
INDIANAPOLIS IN
46220
US

V. Phone/Fax

Practice location:
  • Phone: 317-934-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETTE OLIVER PARRAN
Title or Position: CEO
Credential:
Phone: 317-934-0012