MEDICARE: MERIDIAN RECOVERY 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1336890888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN RECOVERY LLC

Provider Business Mailing Address
First Line	:	3960 SOUTHEASTERN AVE # 5
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1923
Country	:	US
Telephone Number	:	317-784-4402
Fax Number	:

Authorized Official
Title or Position	:	IN-HOUSE COUNSEL
Name	:	ELIZABETH MURPHY
Credential	:
Telephone Number	:	314-258-1037

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	09/13/2022

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Directions to “MERIDIAN RECOVERY LLC ” Practice Location

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