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General NPI Number Information
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NPI Number | 1174317143
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Entity Type | Organization
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Legal Business Name | INDY TEEN TREATMENT CENTER LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 6620 PARKDALE PL STE N
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-4697
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Country | US
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Telephone | 845-372-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 ROUTE 88 STE 5
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City | BRICK
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State | NJ
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Zip | 08724-2371
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Country | US
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Telephone | 845-372-6480
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER ZEIGER
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Credential |
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Telephone | 845-372-6480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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