Healthcare Provider Details

I. General information

NPI: 1104826015
Provider Name (Legal Business Name): BARRY & JOHNSON, ASSOC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 N SHERMAN DR
INDIANAPOLIS IN
46218-2173
US

IV. Provider business mailing address

3208 N SHERMAN DR
INDIANAPOLIS IN
46218-2173
US

V. Phone/Fax

Practice location:
  • Phone: 317-543-0681
  • Fax: 317-543-0753
Mailing address:
  • Phone: 317-543-0681
  • Fax: 317-543-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: BERDER M JOHNSON
Title or Position: OWNER
Credential:
Phone: 317-543-0681