MEDICARE: PATRICE PADRON ADMINISTRATOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	373H00000X	Day Training/Habilitation Specialist
2	376K00000X	Nurse's Aide	IN
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1013501675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE PADRON ADMINISTRATOR

Provider Business Mailing Address
First Line	:	55 S STATE AVE STE 210
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-682-7394
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE STE 210
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-682-7394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	04/04/2023

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