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General NPI Number Information
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NPI Number | 1255459517
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Entity Type | Organization
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Legal Business Name | NORMAL LIFE OF INDIANA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 8206 BUCK RIDGE TRL
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City | EVANSVILLE
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State | IN
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Zip | 47712-7639
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Country | US
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Telephone | 502-394-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-5186
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Country | US
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Telephone | 502-394-2100
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | DENISHA CONNOR
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Credential |
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Telephone | 502-630-7421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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