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General NPI Number Information
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NPI Number | 1326519661
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Entity Type | Organization
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Legal Business Name | MUSLIM RE-ENTRY NETWORK OF INDIANA
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 5525 GEORGETOWN RD STE E
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3717
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Country | US
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Telephone | 317-313-8923
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Fax |
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Provider Business Mailing Address
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Address Line | 4961 SEVILLE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-2176
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Country | US
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Telephone | 317-313-8923
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Fax |
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Authorized Official
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Title or Position | EX. DIRECTOR
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Name | MR. KHABIR A SHAREEF
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Credential |
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Telephone | 317-313-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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