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General NPI Number Information
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NPI Number | 1811483308
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Entity Type | Organization
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Legal Business Name | INDIANA RECOVERY CENTERS LLC
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 01/19/2019
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Provider Practice Location Address
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Address Line | 1130 W JEFFERSON ST STE B
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City | FRANKLIN
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State | IN
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Zip | 46131-2760
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Country | US
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Telephone | 561-602-3427
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Fax | 317-739-3909
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Provider Business Mailing Address
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Address Line | 1130 W JEFFERSON ST STE B
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City | FRANKLIN
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State | IN
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Zip | 46131-2760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BLAKE L BEACH
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Credential |
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Telephone | 772-341-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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