Healthcare Provider Details

I. General information

NPI: 1992469365
Provider Name (Legal Business Name): WELLPATH COMMUNITY CARE CENTERS OF INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5071 E 10TH ST
INDIANAPOLIS IN
46201-2863
US

IV. Provider business mailing address

1283 MURFREESBORO PIKE STE 500
NASHVILLE TN
37217-2421
US

V. Phone/Fax

Practice location:
  • Phone: 615-258-8631
  • Fax:
Mailing address:
  • Phone: 615-258-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN DESCOTEAUX
Title or Position: PC OWNER
Credential: MD
Phone: 508-246-2202