Healthcare Provider Details

I. General information

NPI: 1558819037
Provider Name (Legal Business Name): ECHELON SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 W 71ST ST
INDIANAPOLIS IN
46268-5722
US

IV. Provider business mailing address

4040 W 71ST ST
INDIANAPOLIS IN
46268-5722
US

V. Phone/Fax

Practice location:
  • Phone: 317-798-9690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA SMITH
Title or Position: OWNER
Credential:
Phone: 317-798-9690