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General NPI Number Information
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NPI Number | 1366082091
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Entity Type | Organization
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Legal Business Name | CELTIC RECOVERY, LLC
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 5660 MADISON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-4671
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Country | US
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Telephone | 949-514-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 5660 MADISON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-4671
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Country | US
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Telephone | 949-514-9253
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PETER COLUMBA MOLLOY
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Credential | CADC-I
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Telephone | 949-514-9253
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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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