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General NPI Number Information
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NPI Number | 1972377703
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Entity Type | Organization
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Legal Business Name | SAINT DAMIAN SERVICES LLC
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 3902 MADISON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1312
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Country | US
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Telephone | 317-383-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 320 N MERIDIAN ST STE 1006
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1764
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Country | US
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Telephone | 317-383-1183
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. TERRANCE KINNARD
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Credential |
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Telephone | 131-738-3118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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