MEDICARE: AMICUS RENEW & 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1356292262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMICUS RENEW & RECOVERY LLC

Provider Business Mailing Address
First Line	:	9065 CRYSTAL LAKE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-6414
Country	:	US
Telephone Number	:	765-425-7794
Fax Number	:	317-863-7462

Provider Business Practice Location Address
First Line	:	4701 N KEYSTONE AVE STE 501
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1581
Country	:	US
Telephone Number	:	765-425-7794
Fax Number	:	317-863-7462

Authorized Official
Title or Position	:	CEO
Name	:	GEORGE D DAVIDSON JR.
Credential	:
Telephone Number	:	765-425-7794

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “AMICUS RENEW & RECOVERY LLC ” Practice Location

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