Healthcare Provider Details

I. General information

NPI: 1649650235
Provider Name (Legal Business Name): DAMIEN CARES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 N ARSENAL AVE
INDIANAPOLIS IN
46201-3808
US

IV. Provider business mailing address

26 N ARSENAL AVE
INDIANAPOLIS IN
46201-3808
US

V. Phone/Fax

Practice location:
  • Phone: 317-632-0123
  • Fax: 317-632-4362
Mailing address:
  • Phone: 317-632-0123
  • Fax: 317-423-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003339A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA BUNDY
Title or Position: CLINIC PROJECT SPECIALIST
Credential:
Phone: 317-632-0123