Healthcare Provider Details

I. General information

NPI: 1902265267
Provider Name (Legal Business Name): SUPPORTIVE COMMUNITY INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 GILMORE RIDGE RD
NASHVILLE IN
47448-9731
US

IV. Provider business mailing address

9900 GILMORE RIDGE RD
NASHVILLE IN
47448-9731
US

V. Phone/Fax

Practice location:
  • Phone: 812-322-0313
  • Fax:
Mailing address:
  • Phone: 812-322-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR F KRUGGEL IV
Title or Position: OWNER
Credential: MS, BCBA
Phone: 812-322-0313