Healthcare Provider Details

I. General information

NPI: 1467824698
Provider Name (Legal Business Name): ACORN ADDICTION CENTERS LLC DBA JOURNEY ROAD TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N POST ROAD STE. 4
INDIANAPOLIS IN
46219-4225
US

IV. Provider business mailing address

1201 N POST ROAD STE. 4
INDIANAPOLIS IN
46219-4225
US

V. Phone/Fax

Practice location:
  • Phone: 317-405-8833
  • Fax: 317-672-2398
Mailing address:
  • Phone: 317-405-8833
  • Fax: 317-672-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARI ANNA SHEPHERD
Title or Position: DIRECTOR
Credential:
Phone: 317-405-8833