MEDICARE: SELAH HOUSE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083383129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELAH HOUSE, LLC

Provider Business Mailing Address
First Line	:	1035 MONTICELLO DR
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46011-1223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 TOWN CENTER BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7148
Country	:	US
Telephone Number	:	812-484-1828
Fax Number	:	812-315-3250

Authorized Official
Title or Position	:	CFO
Name	:	BENJAMIN BRADY
Credential	:
Telephone Number	:	615-864-8145

Provider Enumeration Date	:	09/11/2021
Last Update Date	:	04/06/2026

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Directions to “SELAH HOUSE, LLC ” Practice Location

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