Healthcare Provider Details

I. General information

NPI: 1851740302
Provider Name (Legal Business Name): CALMARE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 N SHADELAND AVE STE 230
INDIANAPOLIS IN
46250-2036
US

IV. Provider business mailing address

7430 N SHADELAND AVE STE 230
INDIANAPOLIS IN
46250-2036
US

V. Phone/Fax

Practice location:
  • Phone: 317-991-5710
  • Fax: 317-755-1807
Mailing address:
  • Phone: 317-991-5710
  • Fax: 317-755-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number08001559A
License Number StateIN

VIII. Authorized Official

Name: DR. TERRY JOE TOLLE
Title or Position: MANAGING EMPLOYEE
Credential: DC
Phone: 317-442-1515