MEDICARE: L.A.S.E.R. PROJECT INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	385H00000X	Respite Care
3	385HR2065X	Child Physical Disabilities Respite Care
4	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1497236814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.A.S.E.R. PROJECT INC

Provider Business Mailing Address
First Line	:	9264 DUNWOODY LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-1016
Country	:	US
Telephone Number	:	317-900-2803
Fax Number	:

Provider Business Practice Location Address
First Line	:	6433 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-6677
Country	:	US
Telephone Number	:	317-900-2803
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JACKIE THOMAS JR.
Credential	:
Telephone Number	:	317-900-2803

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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