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General NPI Number Information
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NPI Number | 1114625357
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Entity Type | Organization
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Legal Business Name | RED ROAD VENTURES LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 5454 LEONE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1748
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Country | US
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Telephone | 317-626-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 5454 LEONE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1748
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Country | US
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Telephone | 317-626-4387
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | JOHN MARTIN DICKERSON
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Credential |
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Telephone | 317-626-4387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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