MEDICARE: REM INDIANA

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	2524T0005DE08	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100249080	OTHER	IN	PROVIDER NUMBER

General Provider Information

NPI Number	:	1497887574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM INDIANA

Provider Business Mailing Address
First Line	:	9000 KEYSTONE XING STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-2148
Country	:	US
Telephone Number	:	317-581-2380
Fax Number	:	317-581-2378

Provider Business Practice Location Address
First Line	:	417 W WALNUT ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46901-8406
Country	:	US
Telephone Number	:	765-459-0175
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRETT IAN COHEN
Credential	:
Telephone Number	:	317-581-2380

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	04/19/2023

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Directions to “REM INDIANA ” Practice Location

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