MEDICARE: LIVING HOME

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1497001366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING HOME

Provider Business Mailing Address
First Line	:	6350 WESTHAVEN DR STE F
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2731
Country	:	US
Telephone Number	:	317-291-9388
Fax Number	:	317-291-9389

Provider Business Practice Location Address
First Line	:	6350 WESTHAVEN DR STE F
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2731
Country	:	US
Telephone Number	:	317-291-9388
Fax Number	:	317-291-9389

Authorized Official
Title or Position	:	CEO
Name	:	MR. SAM A ADEYANJU
Credential	:	MS
Telephone Number	:	317-291-9388

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

Similar Medicare Providers

1083932321 — MR. ADETUNJI SAMUEL ADEYANJU
Practice Location Address:

6350 WESTHAVEN DR STE F
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Practice Fax:

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1457283749 — DR. JOSEPH HOUSTON DDS
Practice Location Address:

8853 ROCKVILLE RD
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1407976335 — COMFORT DENTAL CARE
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1710198338 — JILL M HOUSTON D.D.S.
Practice Location Address:

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Directions to “LIVING HOME ” Practice Location

Language	Start Address	Practice Location

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