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General NPI Number Information
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NPI Number | 1407980170
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Entity Type | Organization
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Legal Business Name | INDIANA MENTOR
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 9000 KEYSTONE XING STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2148
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Country | US
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Telephone | 317-581-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 8777 PURDUE RD STE 360
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3121
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Country | US
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Telephone | 317-208-7739
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Fax | 617-790-4271
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Authorized Official
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Title or Position | VP & SR. ASST GENERAL COUNSEL
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Name | MARY PATRICIA RODENBERG-ROBERTS
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Credential |
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Telephone | 952-836-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 200193830
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License Number State | IN
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