Healthcare Provider Details

I. General information

NPI: 1790732444
Provider Name (Legal Business Name): ALLIANCE ADULT DAY SERVICES WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 ROCKVILLE RD
INDIANAPOLIS IN
46214-3073
US

IV. Provider business mailing address

9615 N COLLEGE AVE
INDIANAPOLIS IN
46280-1627
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-2939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JANICE ROBERTS
Title or Position: CEO
Credential:
Phone: 317-581-1100