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General NPI Number Information
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NPI Number | 1164920682
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Entity Type | Organization
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Legal Business Name | INDEPENDENT ADULT DAY CARE CENTERS
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1919 E 52ND ST STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-1381
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Country | US
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Telephone | 317-296-8815
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Fax | 317-983-2168
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Provider Business Mailing Address
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Address Line | 1919 E 52ND ST STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-1381
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Country | US
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Telephone | 317-296-8815
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Fax | 317-608-2802
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY LUGOSCH
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Credential |
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Telephone | 317-296-8815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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