Healthcare Provider Details

I. General information

NPI: 1902621832
Provider Name (Legal Business Name): WHATEVER IT TAKES HOUSING PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 N TACOMA AVE
INDIANAPOLIS IN
46218-1145
US

IV. Provider business mailing address

3637 N TACOMA AVE
INDIANAPOLIS IN
46218-1145
US

V. Phone/Fax

Practice location:
  • Phone: 317-702-0720
  • Fax:
Mailing address:
  • Phone: 317-702-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALARIE GIBSON
Title or Position: OWNER
Credential: MASTER PSYCH/ BS
Phone: 317-702-0720