Healthcare Provider Details

I. General information

NPI: 1992801385
Provider Name (Legal Business Name): DAMAR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 KENTUCKY AVE
INDIANAPOLIS IN
46221-9704
US

IV. Provider business mailing address

PO BOX 41
CAMBY IN
46113-0041
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax: 317-856-2333
Mailing address:
  • Phone: 317-856-5201
  • Fax: 317-856-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JIM L. DALTON
Title or Position: CEO
Credential:
Phone: 317-281-4545