Healthcare Provider Details

I. General information

NPI: 1447095716
Provider Name (Legal Business Name): 6330 DIGITAL WAY OPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 DIGITAL WAY
INDIANAPOLIS IN
46278-1667
US

IV. Provider business mailing address

133 HOLIDAY CT STE 102
FRANKLIN TN
37067-1386
US

V. Phone/Fax

Practice location:
  • Phone: 314-473-6688
  • Fax: 833-645-0909
Mailing address:
  • Phone: 629-257-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALICIA NEAL
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 629-257-8260