Healthcare Provider Details

I. General information

NPI: 1295464147
Provider Name (Legal Business Name): ACCENTUS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 E STOP 11 RD STE 30
INDIANAPOLIS IN
46237-6336
US

IV. Provider business mailing address

5136 E STOP 11 RD STE 30
INDIANAPOLIS IN
46237-6336
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-4169
  • Fax: 463-777-5840
Mailing address:
  • Phone: 317-721-4169
  • Fax: 463-777-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JASON SHAKE
Title or Position: CEO/OWNER
Credential:
Phone: 317-474-2150