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General NPI Number Information
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NPI Number | 1225262702
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Entity Type | Organization
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Legal Business Name | ESSENTIAL DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 1426 W 29TH ST STE 209
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4993
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Country | US
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Telephone | 317-924-2824
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Fax | 317-924-4922
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Provider Business Mailing Address
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Address Line | 1426 W 29TH ST STE 209
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4993
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Country | US
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Telephone | 317-924-2824
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Fax | 317-924-4922
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Authorized Official
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Title or Position | CHIEF OPERATIONAL MANAGER
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Name | MS. DORIS WALKER JONES
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Credential | COUNSELOR
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Telephone | 317-924-2824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 20042020A
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License Number State | IN
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