MEDICARE: THE BROWN BUILDING 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	251S00000X	Community/Behavioral Health Agency	87001136A	IN

General Provider Information

NPI Number	:	1508232190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BROWN BUILDING LLC

Provider Business Mailing Address
First Line	:	55 S STATE AVE
Second Line	:	SUITE 393
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-525-0226
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVENUE
Second Line	:	SUITE 393
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3873
Country	:	US
Telephone Number	:	317-525-0226
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KERI LYNN WIMBERLY-BROWN
Credential	:	LCAC
Telephone Number	:	317-525-0226

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	08/18/2015

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Directions to “THE BROWN BUILDING LLC ” Practice Location

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