Healthcare Provider Details

I. General information

NPI: 1881562858
Provider Name (Legal Business Name): ROVERS HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3352 FOREST MANOR AVE
INDIANAPOLIS IN
46218-2262
US

IV. Provider business mailing address

8837 BROWNS VALLEY LN
CAMBY IN
46113-8821
US

V. Phone/Fax

Practice location:
  • Phone: 317-610-1212
  • Fax:
Mailing address:
  • Phone: 317-610-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LAKISHA WINTERS
Title or Position: CEO
Credential:
Phone: 317-610-1212