=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477994275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWISH FEDERATION OF GREATER INDIANAPOLIS/ALBERT & SARA REUBEN SENIOR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2013
-----------------------------------------------------
Last Update Date | 07/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6905 HOOVER RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-259-6824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6905 HOOVER RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-259-6824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REUBEN CENTER DIRECTOR
-----------------------------------------------------
Name | LORI MOSS
-----------------------------------------------------
Credential | ACSW, LCSW
-----------------------------------------------------
Telephone | 317-259-6824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------