Healthcare Provider Details

I. General information

NPI: 1548036262
Provider Name (Legal Business Name): VALLE VISTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 W 86TH ST STE D
INDIANAPOLIS IN
46268-1779
US

IV. Provider business mailing address

4010 W 86TH ST STE D
INDIANAPOLIS IN
46268-1779
US

V. Phone/Fax

Practice location:
  • Phone: 317-647-0102
  • Fax:
Mailing address:
  • Phone: 317-647-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-382-3319