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General NPI Number Information
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NPI Number | 1659404622
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Entity Type | Organization
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Legal Business Name | REM INDIANA
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 926 S 10TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-1406
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Country | US
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Telephone | 765-423-4280
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Fax |
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Provider Business Mailing 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 | 317-581-2378
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Authorized Official
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Title or Position | COOS
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Name | BRETT IAN COHEN
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Credential |
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Telephone | 800-388-5150
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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 | 2524I0002DE08
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License Number State | IN
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